Low vitamin D and kidney function decline among HIV-infected adults in Thailand

Abstract

Background: Each respective prevalence of hypovitaminosis D and Chronic Kidney Diseases (CKD) is high among Thai HIV-infected adults. Therefore, we examined the factors, including hypovitaminosis D, associated with kidney function decline among chronically treated HIV-infected Thai adults. Methods: We analyzed participants, who were on suppressive combination antiretroviral therapy (ART) from the HIV-NAT long-term cohort, with estimated Glomerular filtration rate(eGFR) measured at least twice a year. Baseline were defined as when participants had a serum 25 (OH)D measured, with eGFR (>60 ml/min/1.73m2 by CKD-EPI equations). The primary outcome was kidney function assessment in terms of eGFR decline. Results: A total of 435 participants was observed through median follow-up of 30 (12 – 54) months. Median age was 44.4 (37.5-53.2) years old. Median serum 25(OH)D was 22.35 (17.5-28.4) ng/ml. Median baseline eGFR was 96.5(83.6-106.4) ml/min/1.73m2, and 50% and 29% of participants were vitamin D insufficient and deficient respectively. GEE model showed coefficients of study factors on eGFR decline as follows: Low vitamin D -0.03 (95%CI: -3.28, 3.23) p 0.988; Follow-up in months -0.07 (95%CI: -0.09, -0.04) p< 0.001; age in years -0.20 (95%CI: -0.40, -0.01) P 0.042; being female 1.83 (95%CI: -0.79, 4.45) p 0.172 ;BMI -0.05 (95%CI: -0.37, 0.26) p 0.750 ;baseline eGFR 0.77 (95%CI: 0.67, 0.87) p<0.001; baseline HIV-RNA (log 10 copies/ml) -1.87 (95%CI: -4.47, 0.74) p 0.161 ; diabetes mellitus -1.98 (95%CI: -5.72, 1.77) p 0.301 ; hypertension -1.51 (95%CI: -4.38, 1.36) p 0.302; gout -2.19 (95%CI: -11.93, 7.54) p 0.659; co-infection with HBV -6.23 (95%CI: -13.28, 0.82) p 0.083; co-infection with HCV 5.68 (95%CI: -1.27, 12.62) p 0.109; previous exposure of PIs 0.08 (95%CI: -0.25, 0.41) p 0.632;current use of EFV2.87 (95%CI: 1.03, 4.70) p 0.002. Conclusions: Among HIV-infected Thai adults, low vitamin D is not significantly associated with eGFR decline whereas age in years, follow-up duration in months, baseline eGFR, and current use of EFV were statistically significant. Further studies in larger populations with multi-ethnic groups are warranted.