Management of Chronic Kidney Disease in Patients Infected With HIV

IDSA recommends monitoring creatinine-based estimated glomerular filtration rate (GFR) when antiretroviral therapy (ART) is initiated or changed, and at least twice yearly in stable HIV-infected patients using the same estimation method to track trends over time. More frequent monitoring may be appropriate for patients with additional kidney disease risk factors. (SR, L)

IDSA suggests monitoring kidney damage with urinalysis or a quantitative measure of albuminuria/proteinuria at baseline, when ART is initiated or changed, and at least annually in stable HIV-infected patients. More frequent monitoring may be appropriate for patients with additional kidney disease risk factors. (WR, L)

IDSA recommends that clinicians prescribe ART and encourage persistence with therapy in HIV-infected patients who have CKD or ESRD, since ART reduces mortality but is underused in this patient population. (SR, M)

IDSA recommends that clinicians use either the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation to estimate GFR or the Cockcroft-Gault equation to estimate creatinine clearance (CrCl) when dosing antiretroviral drugs or other drugs that require reduced doses in patients with reduced kidney function. (SR, M)

IDSA recommends that patients with biopsy-confirmed or clinically suspected HIV-associated nephropathy (HIVAN) receive ART to reduce the risk of progression to ESRD. (SR, M)

In patients infected with HIV who have a GFR <60 mL/min/1.73 m², IDSA recommends avoiding tenofovir and other potential nephrotoxic drugs (eg, nonsteroidal anti-inflammatory drugs) when feasible. (SR, L)

In tenofovir-treated patients who experience a confirmed GFR decline by >25% from baseline and to a level <60 mL/min/1.73 m², IDSA recommends substituting alternative antiretroviral drug(s) for tenofovir, particularly in those with evidence of proximal tubular dysfunction. (SR, L)