Maintenance hemodialysis in patients with HIV-associated nephropathy

Objective: End-stage renal disease (ESRD) patients infected with human immu nodeficiency virus (HIV) have poor survival on maintenance hemodialysis. On ly a few studies have evaluated survival time on the basis of demographic a nd clinical factors. The clinical category of the HIV infection and total C D4 counts are commonly considered determining factors of survival in these HIV-infected dialysis patients. Patients and methods: A retrospective case review of all ESRD patients with HIV infection on maintenance hemodialysis, from January 1987 through December 1996, was performed to determine the im pact of different clinical categories of HIV infection and CD4 counts on su rvival and to see if there are other factors that can predict survival amon g these patients. From a total of 75 ESRD patients with HIV infection, 58 p atients with ESRD due to HIV-associated nephropathy (HIVAN) on maintenance hemodialysis are reported here. Results: During the 10 year study period, 5 2 of 58 ESRD patients with HIVAN expired. Infection (60%), cardiogenic cond itions (13%), cerebro-vascular accidents (6%), HIV wasting (8%) and noncomp liance with dialysis (11%) were common causes of death. Fifty patients who were on long term hemodialysis (Group I), had a median survival time of 11 months (4-69). Among 44 diseased patients in Group I, various demographic, clinical and laboratory markers, including age, sex, race, acquired immunod eficiency syndrome (AIDS)-associated conditions, HIV clinical categories, h emodialysis access and initial serum albumin level were not significantly a ssociated with mean or median survival time. Those with initial CD4 counts of more than 50 had a significantly longer median survival (11.3 months) th an those whose counts were below 50 (5.3 months). Patients with less than o r equal to 2.5 g/100 mi initial serum albumin level and less than or equal to 50 initial CD4 counts had a median survival time of 5.3 months compared to 13.6 months in the group of patients with initial serum albumin level of >2.5 g/100 mi and initial CD4 counts >50. Both of these findings were stat istically significant. Conclusions: Our 10 year experience of maintenance h emodialysis in ESRD patients with HIVAN shows that long term survival is po ssible. Initial CD4 + T cells of less than or equal to 50 in these patients is a poor prognostic marker. HIV clinical categories, as reported by other s, failed to predict survival in our long term experience. Initial serum al bumin of less than or equal to 2.5 g/100 mi was associated with poor surviv al, though statistically not significant. When initial serum albumin of les s than or equal to 2.5 g/100 mi was combined with CD4 + T cells of less tha n or equal to 50, it became another marker of poor survival.