Document Detail


Determinants of survival among HIV-infected chronic dialysis patients.
MedLine Citation:
PMID:  12707399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.
Authors:
Rudolph A Rodriguez; Michael Mendelson; Ann M O'Hare; Ling Chin Hsu; Patricia Schoenfeld
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  14     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-04-22     Completed Date:  2003-06-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1307-13     Citation Subset:  IM    
Affiliation:
University of Califirnia Renal Center, Building 100, Room 350 (box 1341), San Francisco General Hospital, San Francisco, CA 94110, USA. Rudy@itsa.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / mortality*
Adult
Female
Humans
Kidney Failure, Chronic / mortality*,  therapy
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Renal Dialysis / mortality*
San Francisco / epidemiology
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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