HIV-infected patients are at particular risk of CKD, which is often related to CNICM, such as diabetes and hypertension. Non-infectious comorbidities are increasingly common, with the increased survival and ageing of the HIV-infected patient population.
- CKD in HIV-infected patients is associated with poorer patient outcomes, including higher morbidity and mortality. CKD is often associated with cardiovascular disease.
- HIV-infected patients should be screened regularly for CKD to allow for its early detection and management.
- Potentially nephrotoxic antiretroviral drugs should be avoided if a patient is at high risk of renal disease, or if there is evidence of established renal disease. Regardless of the type of ART used, all HIV-infected patients are at risk of CKD and should be routinely screened for renal risk factors and for the presence of CKD.
- For HIV-infected patients at high risk of CKD, blood pressure control, treatment of hyperglycaemia, hyperlipidaemia and attention to lifestyle factors, such as weight loss and smoking cessation, are important. Control of established hypertension with an ACE-inhibitor or an ARB is indicated, particularly if there is proteinuria at baseline.
- The number of patients with HIV infection and ESRD is increasing. These patients may require treatment with dialysis or renal transplantation.