Black HIV patients at risk for kidney failure

By Megan Rauscher

NEW YORK (Reuters Health) - Black people infected with HIV are at much higher risk for kidney failure, also known as end-stage renal disease, than are their white counterparts. In fact, the risk seen with HIV infection in blacks is comparable to that observed with diabetes, a well known cause of kidney disease.

"This finding highlights the importance of efforts to improve the management of kidney disease among black patients with HIV infection," first author Dr. Andy I. Choi of San Francisco General Hospital told Reuters Health.

While it is known that HIV infection can cause kidney disease, few studies have quantified the risk of kidney failure associated with HIV infection, Choi and colleagues note in the Journal of the American Society of Nephrology.

They used a group of more than 2 million patients in the VA health care system to compare rates of kidney failure in patients with HIV and those with diabetes. About 15,000 of the study subjects had HIV infection -- a rate of 0.8 percent -- and 54 percent of the HIV-infected individuals were African American.

"Our study demonstrated a striking and unexpected degree of (kidney failure) among HIV-infected persons of black race," Choi said. "We can think of few other risk factors for (kidney failure) that are modified to this extent by race."

He and his colleagues encourage doctors to screen for kidney disease according to current Infectious Disease Society of America guidelines, using a urine test, in all individuals diagnosed with HIV infection.

Patients with risk factors for chronic kidney disease such as black race, low immune cell counts, high blood levels of HIV, diabetes, high blood pressure, or additional infection with hepatitis C virus should undergo annual screening, they advise.

"Our hope is that these results help to establish kidney disease as a research priority in the HIV-infected community," Choi said.

SOURCE: Journal of the American Society of Nephrology, November 2007.