Screening and management of renal disease in human immunodeficiency virus-infected patients in Australia
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Gracey, D and Chan, D and Bailey, M and Richards, D and Dalton, B, Screening and management of renal disease in human immunodeficiency virus-infected patients in Australia, Internal Medicine Journal, 43, (4) pp. 410-416. ISSN 1444-0903 (2013) [Refereed Article]
Copyright 2012 The Authors Internal Medicine Journal Copyright 2012 Royal Australasian College of Physicians
Background: Renal disease has become one of the most important comorbidities observed in the human immunodeficiency virus (HIV)-infected patient cohort. Data are lacking on the current screening and management of renal disease in patients with HIV. We evaluated HIV-infected Australian adults in primary care to determine current practices. Methods: This prospective, multicentre observational study included two rounds of data collection; the first was followed by an educational programme. Outcomes included screening for renal disease; management of risk factors for kidney disease and other comorbidities associated with renal disease. Results: Fifty-three general practitioners participated with 733 patients enrolled. Most were male (94%); almost 40% were 41-50 years of age, and 6% and 84% were receiving antiretroviral therapy. Comorbidities were common; 19% had hypertension, 5% were diabetic, 32% were dyslipidaemic, and 40% were smokers. Estimated glomerular filtration rate was commonly measured in both rounds of data collection (96% vs 95%). Proteinuria was assessed less frequently; this improved after education (48% vs 71%). Almost 10% of patients tested had proteinuria on urinalysis. Of the 45 patients (6%) with renal impairment (estimated glomerular filtration rate <60mL/min), none was referred for assessment by a renal specialist. Conclusions: This large observational study provides important information on renal disease in HIV-infected patients, an area with a paucity of clinical data. Current screening and management practices fall short of suggested guidelines. Failure to refer patients to specialists is a major deficiency. Improvements with education suggest the need to promote awareness of guidelines in primary care doctors. © 2012 Royal Australasian College of Physicians.
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