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Clinical outcomes of a combined HIV and renal clinic.

McClure M, Singh GJ, Rayment M, Jones R, Levy JB - Clin Kidney J (2012)

Bottom Line: We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records.Most patients were discharged back to their main HIV teams for ongoing follow-up.A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.

View Article: PubMed Central - PubMed

Affiliation: Imperial College Renal and Transplant Centre , Imperial College Healthcare NHS Trust , London , UK.

ABSTRACT

Background: Renal disease is an emerging problem in patients living with human immunodeficiency virus (HIV), as illustrated by an increased incidence of acute kidney injury and chronic kidney disease (CKD) from HIV, its associated treatment and comorbidities such as diabetes and vascular disease. We have established a combined HIV-renal clinic to manage such patients, enhance their treatment and minimize outpatient visits.

Methods: We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records. These ninety-nine patients were referred to the service from HIV physicians in West London and all the patients were seen jointly by an HIV and a renal consultant.

Results: Sixty-five percent of the patients were referred with reduced renal function or proteinuria [mean creatinine at presentation 136 mcmol/L, estimated glomerular filtration rate (eGFR) 57 mL/min/1.73 m(2)]. The majority (53%) had risk factors predisposing to vascular disease including diabetes, hypertension, previous stroke or myocardial infarction. Overall, 27% of patients had a renal diagnosis directly associated with HIV (HIVAN, immune complex nephritis, tenofovir toxicity, Fanconi syndrome), 73% had an alternative possible cause. Twenty-seven percent of patients had low-level proteinuria (urine protein:creatinine ratio abnormal but <100 mg/mmol) or mildly reduced eGFR (40-66 mL/min/1.73 m(2)) without a clear underlying cause. Ten percent of patients were thought to have tenofovir-induced renal damage all of whom improved on cessation of this agent. Following the review in the combined clinic, 64% of patients had a change in treatment or management, with 50% improving their renal parameters as a result. Most patients were discharged back to their main HIV teams for ongoing follow-up.

Conclusions: A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.

No MeSH data available.


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Mentions: Twenty-five patients (25%) had a pre-existing renal diagnosis. The majority of patients (65%) were referred due to raised serum creatinine or reduced estimated glomerular filtration rate (eGFR). Thirty-nine patients (39%) were found to have proteinuria as well as reduced eGFR. Twenty-nine patients (29%) presented with proteinuria alone (Figure 1). The mean creatinine at presentation was 136 mcmol/L (sd 54), eGFR 57 mL/min/1.73 m2 (SD 19) and the urine protein:creatinine ratio was 90 mg/mmol (SD 123) (Table 1). Fifty-three (53%) patients had risk factors predisposing to vascular disease. Ten (10%) patients were diabetic: five of these presented with proteinuria and five with worsening eGFR. Eight out of these ten were given a clinical diagnosis of diabetic nephropathy or hypertensive nephropathy, one labelled as CKD-4 with no clear diagnosis and one labelled low-level stable proteinuria. Thirty-nine (39%) were hypertensive: 13 presented with proteinuria and 26 with worsening eGFR. Twenty of the known hypertensive patients were given a clinical diagnosis of hypertensive nephropathy and two had a renal biopsy: both showing HIVAN. The remainder had clinical diagnoses which were mostly low-level stable proteinuria (4) or non-progressive mild CKD (4). Four (4%) had confirmed overt cardiovascular disease (previous stroke or myocardial infarction).Table 1.


Clinical outcomes of a combined HIV and renal clinic.

McClure M, Singh GJ, Rayment M, Jones R, Levy JB - Clin Kidney J (2012)

Indication for referral.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400564&req=5

SFS141F1: Indication for referral.
Mentions: Twenty-five patients (25%) had a pre-existing renal diagnosis. The majority of patients (65%) were referred due to raised serum creatinine or reduced estimated glomerular filtration rate (eGFR). Thirty-nine patients (39%) were found to have proteinuria as well as reduced eGFR. Twenty-nine patients (29%) presented with proteinuria alone (Figure 1). The mean creatinine at presentation was 136 mcmol/L (sd 54), eGFR 57 mL/min/1.73 m2 (SD 19) and the urine protein:creatinine ratio was 90 mg/mmol (SD 123) (Table 1). Fifty-three (53%) patients had risk factors predisposing to vascular disease. Ten (10%) patients were diabetic: five of these presented with proteinuria and five with worsening eGFR. Eight out of these ten were given a clinical diagnosis of diabetic nephropathy or hypertensive nephropathy, one labelled as CKD-4 with no clear diagnosis and one labelled low-level stable proteinuria. Thirty-nine (39%) were hypertensive: 13 presented with proteinuria and 26 with worsening eGFR. Twenty of the known hypertensive patients were given a clinical diagnosis of hypertensive nephropathy and two had a renal biopsy: both showing HIVAN. The remainder had clinical diagnoses which were mostly low-level stable proteinuria (4) or non-progressive mild CKD (4). Four (4%) had confirmed overt cardiovascular disease (previous stroke or myocardial infarction).Table 1.

Bottom Line: We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records.Most patients were discharged back to their main HIV teams for ongoing follow-up.A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.

View Article: PubMed Central - PubMed

Affiliation: Imperial College Renal and Transplant Centre , Imperial College Healthcare NHS Trust , London , UK.

ABSTRACT

Background: Renal disease is an emerging problem in patients living with human immunodeficiency virus (HIV), as illustrated by an increased incidence of acute kidney injury and chronic kidney disease (CKD) from HIV, its associated treatment and comorbidities such as diabetes and vascular disease. We have established a combined HIV-renal clinic to manage such patients, enhance their treatment and minimize outpatient visits.

Methods: We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records. These ninety-nine patients were referred to the service from HIV physicians in West London and all the patients were seen jointly by an HIV and a renal consultant.

Results: Sixty-five percent of the patients were referred with reduced renal function or proteinuria [mean creatinine at presentation 136 mcmol/L, estimated glomerular filtration rate (eGFR) 57 mL/min/1.73 m(2)]. The majority (53%) had risk factors predisposing to vascular disease including diabetes, hypertension, previous stroke or myocardial infarction. Overall, 27% of patients had a renal diagnosis directly associated with HIV (HIVAN, immune complex nephritis, tenofovir toxicity, Fanconi syndrome), 73% had an alternative possible cause. Twenty-seven percent of patients had low-level proteinuria (urine protein:creatinine ratio abnormal but <100 mg/mmol) or mildly reduced eGFR (40-66 mL/min/1.73 m(2)) without a clear underlying cause. Ten percent of patients were thought to have tenofovir-induced renal damage all of whom improved on cessation of this agent. Following the review in the combined clinic, 64% of patients had a change in treatment or management, with 50% improving their renal parameters as a result. Most patients were discharged back to their main HIV teams for ongoing follow-up.

Conclusions: A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.

No MeSH data available.


Related in: MedlinePlus