Dados do Trabalho

Título

Acute Kidney Injury in Hospitalized HIV/AIDS Patients Prior to Antiretroviral Therapy Initiation

Objetivo (s)

To determine the incidence of acute kidney injury - AKI in newly diagnosed AIDS patients during admission, analyze associated factors, and assess its impact on hospitalization duration and mortality rates.

Material e Métodos

The study was conducted at the Maria Aparecida Pedrossian University Hospital from November 2020 to April 2022. Patients who were diagnosed with AIDS during hospitalization and who were not on antiretroviral therapy were prospectively included. Diagnosis and classification of AKI were based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results were presented as median, first and third quartiles.

Resultados e Conclusão

Sixty-three patients were included, mostly men (n=47; 74.6%), with a median age of 42 years [29; 53] and CD4+ count of 40.5 cells/mm3 [25.0; 104.0]. Almost all (n = 59; 93.7%) showed some opportunistic disease, with predominance of tuberculosis (39.7%), neurotoxoplasmosis (27%), pneumocystosis (23.8%), visceral leishmaniasis (15.9%), and cryptococcosis (15.9%). The cumulative incidence of AKI was 65.1% (95% CI % 52,8% – 75,7%). The median time to diagnose AKI was 5 days [2; 14] after hospitalization. Variables associated with AKI were low CD4+ cell count, cryptococcosis comorbidity, use of amphotericin B, vasopressor drugs, and ventilatory support. The highest classification of AKI (KDIGO 3) was received by 15 (36.6%) patients, and the main causes were sepsis and nephrotoxicity, 8 (53.3%) of them underwent hemodialysis. Patients with AKI remained hospitalized longer than those without AKI, - 32.4±12.8 days vs 16.8±10.7 days (p <0.001). The findings of this study indicate a high incidence of AKI among hospitalized patients with HIV/AIDS, leading to an extended duration of hospitalization. Implementing preventive measures to combat opportunistic diseases, particularly those necessitating the use of amphotericin B deoxycholate, such as cryptococcosis, could potentially mitigate AKI occurrence in HIV/AIDS patients during hospitalization.

Palavras-chave

Acute Kidney Injury. AIDS. Hospitalized. Nephrotoxicity.