Craig Arendse1, Ikechi Okpechi, Charles Swanepoel. 1. Nephrology Division, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. craigarendse@hotmail.com
Abstract
AIM: The prognosis for HIV patients needing acute dialysis is uncertain. The aim of this study was to describe the clinical presentation, renal diagnoses and outcomes of HIV patients who underwent acute haemodialysis at Groote Schuur Hospital in the period 2002-2007. METHODS: A retrospective review of case records of HIV patients who underwent acute haemodialysis was conducted. RESULTS: One hundred and seventeen patients were reviewed (median age 34.0 years (29.0-40.0) 53.8% men, 93.2% black Africans) and 33 had a renal biopsy. Acute tubular necrosis (ATN) was diagnosed in 68 patients. Recovery of renal function occurred in 33.3% of all patients while in 25.7% treatment was withdrawn and 41.0% died in hospital. Suspected ATN was the commonest cause of renal disease in those who recovered renal function (82.1%). A higher CD4 count (odds ratio (OR)=0.994, P=0.007), lower pre-dialysis serum creatinine (<1230 µmol/L) and longer hospitalization (OR=0.93, P=0.006) significantly correlated with survival. CONCLUSION: There is a good chance of survival for HIV patients needing acute dialysis when the diagnosis is ATN, and when the CD4 count is more than 200 cells/mm3.
AIM: The prognosis for HIVpatients needing acute dialysis is uncertain. The aim of this study was to describe the clinical presentation, renal diagnoses and outcomes of HIVpatients who underwent acute haemodialysis at Groote Schuur Hospital in the period 2002-2007. METHODS: A retrospective review of case records of HIVpatients who underwent acute haemodialysis was conducted. RESULTS: One hundred and seventeen patients were reviewed (median age 34.0 years (29.0-40.0) 53.8% men, 93.2% black Africans) and 33 had a renal biopsy. Acute tubular necrosis (ATN) was diagnosed in 68 patients. Recovery of renal function occurred in 33.3% of all patients while in 25.7% treatment was withdrawn and 41.0% died in hospital. Suspected ATN was the commonest cause of renal disease in those who recovered renal function (82.1%). A higher CD4 count (odds ratio (OR)=0.994, P=0.007), lower pre-dialysis serum creatinine (<1230 µmol/L) and longer hospitalization (OR=0.93, P=0.006) significantly correlated with survival. CONCLUSION: There is a good chance of survival for HIVpatients needing acute dialysis when the diagnosis is ATN, and when the CD4 count is more than 200 cells/mm3.
Authors: Ryan E Aylward; Elizabeth van der Merwe; Sisa Pazi; Minette van Niekerk; Jason Ensor; Debbie Baker; Robert J Freercks Journal: BMC Nephrol Date: 2019-12-10 Impact factor: 2.388