The Impact Of Immunosuppression On Chronic Kidney Disease In People Living With Human Immunodeficiency Virus: The D:A:D Study

Background. Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown.Methods. Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 <= 200 cells/mu L, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m(2).Results. Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 <= 200 cells/mu L (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI],.68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI,.24-.80]) vs 0.80 [95% CI,.70-.93]).Conclusions. Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.