UREMIA THERAPY IN PATIENTS WITH END-STAGE RENAL-DISEASE AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - HAS THE OUTCOME CHANGED IN THE 1990S

We conducted a cross-sectional survey to determine the relative course of patients with end-stage renal disease (ESRD) and human immunodefic iency virus (HIV) infection sustained on maintenance hemodialysis, All 34 patients with ESRD and HIV infection receiving hemodialysis in one hospital-based and three community-based outpatient hemodialysis faci lities in Brooklyn, NY, were studied. We documented their known durati on of HIV infection, duration of ESRD, and hemodialysis prescription, and noted the presence of clinical acquired immunodeficiency syndrome (AIDS). Total CD, count, serum albumin concentration, and percent redu ction of urea (predialysis blood urea nitrogen minus postdialysis bloo d urea nitrogen, divided by predialysis blood urea nitrogen x 100) wer e measured. The 34 study subjects (26 men and eight women) included 31 blacks (91%) and three Hispanics (9%) with a mean age of 42 +/- 7.5 y ears, 29 (85%) of whom had AIDS. Twenty subjects (59%) had a history o f intravenous drug abuse. Only six subjects (18%) were receiving an an tiretroviral drug (zidovudine = five, dideoxyinosine = one). In 23 sub jects (68%), AIDS was diagnosed prior to ESRD and was presumed to be t he cause of renal failure (HIV-associated nephropathy). The mean known duration of HIV infection was 50.5 +/- 34 months (median, 48 months); the mean duration of ESRD was 57 +/- 50 months, the mean total CD, co unt was 140 +/- 150 cells/mu L (median, 70 cells/mu L), the mean hemat ocrit was 28% +/- 5%, and the mean serum albumin concentration was 3.5 +/- 0.37 g/dL. All subjects were receiving erythropoietin for anemia correction. The mean length of the prescribed thrice-weekly hemodialys is sessions was 3.5 +/- 0.4 hours. Our results suggest that the surviv al of many ESRD patients with HIV infection receiving hemodialysis has improved compared with the uniformly dismal survival rate reported in the 1980s. Decisions on whether to initiate renal replacement therapy in patients with AIDS and advanced renal failure should be individual ized because the combination of ESRD and HIV infection does not necess arily signal near-term death. (C) 1997 by the National Kidney Foundati on, Inc.