CKD Prediction in HIV+ Patients

CKD Risk Score for HIV Patients

Age

Glucose >140 mg/dL or Diabetes

Hypertension (SBP >140 or on treatment)

CD4 Count <200 cells/µL

HIV RNA >4000 copies/mL

Tenofovir Use

Proteinuria (protein on UA)

Hepatitis C Co-infection

Baseline eGFR <90 mL/min/1.73m²

CKD Risk Score: –

Awaiting input

Select all criteria to compute the score.

Determines probability of HIV patients developing CKD in the next 5 years, if they take tenofivir or not.

Why Use

Low risk patients may be good candidates for tenofovir, and high risk patients should avoid tenofovir when determining appropriate anti-retroviral therapies.

When to Use

Patients who are expected to be low-risk for the development of CKD, to confirm this Patients who are expected to be high-risk for the development of CKD, to make sure alternatives to tenofovir are used

Formula

Addition of selected points.

Pearls / Pitfalls

It is well-known that tenofovir is associated with a higher risk of developing chronic kidney disease (CKD). This risk is substantially higher in patients with traditional CKD risk factors. This risk calculator helps determine risk of developing CKD, and may help practitioners choose patients who would be good or poor candidates for tenofovir depending on their overall CKD risks. This score was developed in a US VA patient population, and only males were included in this study. This population was also overall “healthier” than the general VA population in other cardiovascular and renal disease states, with relatively low rates of hyperglycemia or hypertension.

Critical Actions

Patients with low scores (0 points) may be good candidates for tenofovir. Patients with high scores (≥9 points) should avoid tenofovir in their treatment regimen, given their significantly higher risk of developing CKD within 5 years.

More Information

Category Score* 5-year event rate (95% CI) TDF users 0 1.4 (0.9, 2.2) 1 2.2 (1.4, 3.3) 2 3.6 (2.9, 4.4) 3 5.3 (4.4, 6.5) 4 7.6 (6.6, 8.8) 5 8.6 (7.4, 10.1) 6 10.9 (9.4, 12.6) 7 13.1 (11.1, 15.4) 8 19.4 (16.3, 23.2) ≥9 21.4 (18.1, 25.2) TDF non-users 0 0.5 (0.3, 0.9) 1 0.3 (0.1, 0.8) 2 1.5 (1.2, 2.0) 3 1.9 (1.4, 2.4) 4 2.7 (2.2, 3.3) 5 4.1 (3.4, 4.9) 6 5.1 (4.3, 6.1) 7 8.7 (7.4, 10.2) 8 11.0 (9.2, 13.2) ≥9 16.4 (14.1, 19.2) *Scores of 0 are considered low, while scores ≥9 are considered high.