ToolsCalculators
CKD Prediction in HIV+ Patients
5-year risk of chronic kidney disease in HIV-positive patients with preserved renal function.
CKD Prediction in HIV+ Patients
HIV acquired through injection drug use
Sex
Hepatitis C coinfection
Age
Baseline eGFR
Model derived only in patients with a baseline eGFR >60 mL/min/1.73m².
Nadir CD4 count
Hypertension
Prior cardiovascular disease
Diabetes mellitus
Result0 points
Medium risk of confirmed CKD (eGFR ≤60 mL/min/1.73m² on two measurements >3 months apart) within 5 years, approximately 1.50%.
- Risk group
- Medium
- Estimated 5-year CKD risk
- 1.50 %
When to use
- Estimating 5-year risk of incident CKD in an HIV-positive patient whose renal function is currently preserved (baseline eGFR >60 mL/min/1.73m²).
- Weighing the renal risk/benefit of starting a potentially nephrotoxic antiretroviral such as tenofovir disoproxil fumarate or a boosted protease inhibitor.
Formula
Sum of points: IV drug use +2; female sex +1; hepatitis C +1; age >60 +10, 51-60 +7, 36-50 +4, ≤35 +0; baseline eGFR 60-70 +6, 71-90 +0, >90 -6; nadir CD4 >200 -1, ≤200 +0; hypertension +1; prior cardiovascular disease +1; diabetes +2. Score <0 = low risk (1:393 five-year risk), 0-4 = medium risk (1:47), ≥5 = high risk (1:6).
Pearls and pitfalls
- Derived and validated only in patients with a baseline eGFR >60 mL/min/1.73m² who had not yet been exposed to tenofovir or a boosted protease inhibitor; do not apply once eGFR has already fallen below 60.
- The number needed to harm (NNTH) at 5 years from starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor fell from 739 in the low-risk group to 88 in the medium-risk group and 9 in the high-risk group; for unboosted atazanavir or lopinavir/ritonavir the corresponding NNTH was 1,702, 202, and 21. The score is best used to individualize antiretroviral selection rather than to withhold therapy outright.
- Externally validated in the Royal Free Hospital Clinic Cohort and the SMART/ESPRIT trials with discrimination preserved from the derivation cohort (Harrell's C-statistic 0.92 for the full model and 0.91 for the short model excluding cardiovascular risk factors).