Renal Failure Among Inpatients with HIV in Pennsylvania 2000 – 2011

BACKGROUND: Advances in the treatment of HIV disease prolongs the lifespan of people living with HIV (PLWH); however they may be more likely to suffer from chronic conditions such as renal disease. According to the US Renal Disease System HIV Associated Nephropathy (HIVAN) accounts for approximately 1% of End-Stage Renal Disease in the US and occurs disproportionately among African-American men. The purpose of this analysis is to describe inpatient hospitalization among Pennsylvania residents with concomitant HIV infection and renal failure between 2000 and 2011.    

METHODS: Pennsylvania routinely collects inpatient data from all non-Federal acute care hospitals operating in the state. This analysis uses these inpatient discharge data to describe the renal failure among inpatients with HIV and HIV surveillance data to estimate rates by age, race and gender. Renal failure (acute and chronic renal disease, nephrosis) and HIV infection were identified in the discharge data using Clinical Classification Software to cluster diagnoses into clinically meaningful categories. HIV surveillance data were used to estimate annual HIV prevalence by age, gender and race among people living with HIV during the period of study.

RESULTS:   The analysis indicated that there were 120,562 hospitalization experiences for Pennsylvania residents with HIV infection between 2000 and 2011. Among these hospitalizations, 18,930 (15.7%) also had acute or chronic renal failure or nephrosis. Logistic regression modeling controlling for gender, age and race indicated that black patients with HIV were 2.6 (95% CI 2.4 – 2.7) times more likely to be hospitalized with renal failure than non-black HIV patients and males were 1.4 (95% CI 1.3 – 1.4) times as likely as females. Crude rates of hospitalization increased from 49.1/ 1,000 cases of PLWH in 2000 to 85.7 per 1,000 cases in 2011 with an R-squared value of 0.81. Mean hospital charges for patients with HIV and renal failure ($88,300) were nearly double mean hospital charges for HIV patients without renal failure ($44,300).  

CONCLUSIONS:   Renal failure is an increasingly common complication among PLWH and black males appear to be at higher risk for hospitalization. Renal failure may be associated with a significantly higher risk of death among PLWH and the cost of providing inpatient care for these patients is substantially higher than for patients without renal failure.