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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.


Related in: MedlinePlus

Interventions made at combined HIV–renal clinic. TDF: tenofovir; ACEi: angiotensin-converting enzyme inhibitor; ARV: anti-retroviral agent; MRA: magnetic resonance angiogram.
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SFS141F2: Interventions made at combined HIV–renal clinic. TDF: tenofovir; ACEi: angiotensin-converting enzyme inhibitor; ARV: anti-retroviral agent; MRA: magnetic resonance angiogram.

Mentions: No specific intervention was needed in thirty-five (35%) patients and no change in therapy instituted. In the remaining sixty-four (64%) patients, attendance at the clinic led directly to a change in therapy or management (Figure 2). Most commonly, this included cessation of tenofovir, addition of angiotensin-converting enzyme inhibitors, optimization of blood pressure or diabetes, change of anti-retroviral other than tenofovir, specific investigation such as magnetic resonance angiogram (MRA) of renal arteries or renal biopsy. Fifty (50%) of the patients reviewed had improved renal parameters as a result of the clinic visit. The mean improvement in eGFR was 4.5 mL/min/1.73 m2 (SD 116) at 3 months and 9.5 mL/min/1.73 m2 (SD 10) at 1 year. The mean improvement in the urine protein:creatinine ratio was 55 mg/mmol (SD) at 1 year. Thirty-three (33%) patients had stable and 10 (10%) had worse renal parameters. For this group, the mean deterioration at 1 year in eGFR was 6.15 mL/min/1.73 m2 (SD 10.76) and the mean urine protein:creatinine ratio was 45.6 mg/mmol (SD 120) higher. Forty (40%) continued to have joint specialist HIV–renal follow-up, while 60% were discharged back to their HIV physician with a clear renal management plan.Fig. 2.


Clinical outcomes of a combined HIV and renal clinic.

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

Interventions made at combined HIV–renal clinic. TDF: tenofovir; ACEi: angiotensin-converting enzyme inhibitor; ARV: anti-retroviral agent; MRA: magnetic resonance angiogram.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

SFS141F2: Interventions made at combined HIV–renal clinic. TDF: tenofovir; ACEi: angiotensin-converting enzyme inhibitor; ARV: anti-retroviral agent; MRA: magnetic resonance angiogram.
Mentions: No specific intervention was needed in thirty-five (35%) patients and no change in therapy instituted. In the remaining sixty-four (64%) patients, attendance at the clinic led directly to a change in therapy or management (Figure 2). Most commonly, this included cessation of tenofovir, addition of angiotensin-converting enzyme inhibitors, optimization of blood pressure or diabetes, change of anti-retroviral other than tenofovir, specific investigation such as magnetic resonance angiogram (MRA) of renal arteries or renal biopsy. Fifty (50%) of the patients reviewed had improved renal parameters as a result of the clinic visit. The mean improvement in eGFR was 4.5 mL/min/1.73 m2 (SD 116) at 3 months and 9.5 mL/min/1.73 m2 (SD 10) at 1 year. The mean improvement in the urine protein:creatinine ratio was 55 mg/mmol (SD) at 1 year. Thirty-three (33%) patients had stable and 10 (10%) had worse renal parameters. For this group, the mean deterioration at 1 year in eGFR was 6.15 mL/min/1.73 m2 (SD 10.76) and the mean urine protein:creatinine ratio was 45.6 mg/mmol (SD 120) higher. Forty (40%) continued to have joint specialist HIV–renal follow-up, while 60% were discharged back to their HIV physician with a clear renal management plan.Fig. 2.

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