Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

(Table 1) Carbon content and petroleum potential at DSDP Hole 73-520

At the end of the Leg 73 cruise, at Site 520, a thick upper Miocene facies of laminated diatomite was discovered. It was hypothesized that the sediment was derived from nutrient-rich waters in a young Cenozoic anoxic basin in the open Atlantic Ocean near the Mid-Atlantic Ridge

(Table 1) Organic geochemistry of sediments recovered from DSDP Leg 65 Holes

Pliocene-Pleistocene marls, muds, and hemipelagic clays with some beds of silt and sand were recovered on Leg 65 near the crest of the East Pacific Rise at the mouth of the Gulf of California. The organic matter in the sediments is mainly of marine origin for the upper Pleistocene sediments (0-0.61 m.y.), while the lower Pleistocene deposits (0.61- 1.80 m.y.) are characterized by continental organic matter except near the bottom of the sediment section in Hole 483A, where marine organic matter was found. The sediments belong to an early stage of geochemical evolution, except in Hole 482D, where hydrothermal effects are invoked to explain the maturity of the organic matter above the basement

Organic geochemistry and Rock-Eval pyrolysis at DSDP Leg 79 and 41 Holes

Cenozoic and Mesozoic sediments ranging in age from Pleistocene to Early Jurassic/late Triassic were recovered on DSDP Leg 79, off Morocco at Sites 544 to 547 in front of the Mazagan Plateau. The main zone of oil genesis should be reached at Site 547 within the Jurassic section. Organic material of marine origin with good petroleum potential characterizes the late Eocene slumps of Site 547 and originates from reworked organic matter of Cretaceous origin. Organic enrichment also occurs at Site 545 during the middle to late Albian period. Since the organic matter appears to be autochthonous, reducing environments of deposition are inferred. In the other Cretaceous deposits, variably altered organic matter of the same origin predominates. Finally, a transect including Site 370 off the Agadir Canyon, is studied: detrital organic matter and reducing environments of deposition were more developed during Albian time for Site 370 than for Site 545