End-stage renal disease (
ESRD) patients infected with human immunodeficiency virus (HIV) have poor survival on maintenance
hemodialysis. Only a few studies have evaluated survival time on the basis of demographic and clinical factors. The clinical category of the
HIV infection and total CD4 counts are commonly considered determining factors of survival in these HIV-infected dialysis patients.
PATIENTS AND METHODS: RESULTS: During the 10 year study period, 52 of 58
ESRD patients with HIVAN expired.
Infection (60%), cardiogenic conditions (13%), cerebro-vascular accidents (6%), HIV wasting (8%) and noncompliance 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 immunodeficiency syndrome (
AIDS)-associated conditions, HIV clinical categories,
hemodialysis access and initial
serum albumin level were not significantly associated with mean or median survival time. Those with initial CD4 counts of more than 50 had a significantly longer median survival (11.3 months) than those whose counts were below 50 (5.3 months). Patients with < or = 2.5 g/100 ml initial
serum albumin level and < or = 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 ml and initial CD4 counts > 50. Both of these findings were statistically significant.
CONCLUSIONS: Our 10 year experience of maintenance
hemodialysis in
ESRD patients with HIVAN shows that long term survival is possible. Initial CD4+ T cells of < or = 50 in these patients is a poor prognostic marker. HIV clinical categories, as reported by others, failed to predict survival in our long term experience. Initial
serum albumin of < or = 2.5 g/100 ml was associated with poor survival, though statistically not significant. When initial
serum albumin of < or = 2.5 g/100 ml was combined with CD4+ T cells of < or = 50, it became another marker of poor survival.