hiv and ChrONiC kidney disease WHAT YOU NEED TO KNOW

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1 hiv and ChrONiC kidney disease WHAT YOU NEED TO KNOW

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3 HIV AND CHRONIC KIDNEY DISEASE WHAT YOU NEED TO KNOW CONTENTS What Is HIV?... 2 If I Have HIV, Does It Mean I also Have AIDS?... 2 Why Do I Need to Know about Kidney Disease?... 2 What Are Kidneys and Why Are They Important?... 2 What Is Kidney Disease?... 4 Is Kidney Disease Serious?... 4 Are People with HIV at Greater Risk for Getting Kidney Disease?... 5 Why Does HIV Put Me at Greater Risk for Kidney Disease?... 6 How Will I Know if I Have Kidney Disease?... 7 How Often Should I Be Tested for Kidney Disease?... 8 How Is Kidney Disease Treated?... 8 What Is Kidney Failure?...10 How Is Kidney Failure Treated?...10 What Does Hemodialysis Involve?...11 What Does Peritoneal Dialysis Involve?...12 Can a Patient with HIV Have a Kidney Transplant?...13 How Can I Lower My Chances for Getting Kidney Disease?...13 Where Can I Get More Information?...14 w w w. k i d n e y. o r g 1

4 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW What is HIV? HIV (human immunodeficiency virus) is a virus that infects and damages your immune system. Your immune system helps your body defend itself against infection and other disease. HIV attacks and destroys the disease-fighting cells of your immune system and leaves your body weak against infection and cancer. If I have HIV, does it mean I also have AIDS? Having HIV does not mean that you have AIDS (acquired immune deficiency syndrome). But HIV can lead to AIDS if left untreated. AIDS is the most serious and advanced stage of HIV infection. Why do I need to know about kidney disease? Having HIV may put you at risk for getting chronic kidney disease (CKD). It s hard to know exactly how common it is, but some experts believe that 7 to 30 percent of people with HIV have problems with their kidneys. What are kidneys and why are they important? Think of your kidneys as a coffee filter. When you make coffee, the filter keeps the coffee grains inside but allows water to pass through. Your kidneys do something similar. They keep the things you need inside your body but filter out things you don t need. 2

5 Your kidneys also keep the rest of your body in balance by: Removing waste and poisons from the body Balancing the body s fluids Helping to control blood pressure Helping bones stay healthy Helping to make red blood cells Normal Kidneys and Urinary Tract You have two kidneys. Each kidney is about the size of your fist. They are located near the middle of your back, just below the rib cage. Each kidney has about 1.5 million filters, called nephrons. Nephrons remove waste and extra fluid from your blood in the form of urine. The urine flows through two tubes, called ureters, to the bladder. The urine is stored there until you go to the bathroom. The waste comes from the breakdown of food you eat and medicine you take, plus normal muscle and organ activity. w w w. k i d n e y. o r g 3

6 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW WhaT is kidney disease? Kidney disease means your kidneys don t do what they should. Kidneys can get damaged from a physical injury or a disease like HIV, diabetes, or high blood pressure. Once your kidneys are damaged, they cannot filter your blood or do other jobs as well as they should. There are five stages of kidney disease (shown in the table below). Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Stages of Chronic Kidney Disease (CKD) Stage Description Kidney damage (eg, protein in the urine) with normal GFR Kidney damage with mild decrease in GFR Moderate decrease in GFR Severe reduction in GFR Kidney failure Glomerular Filtration Rate (GFR)* 90 or above 60 to to to 29 Less than 15 *Your GFR number tells your doctor how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases. is kidney disease SEriOuS? Yes. If untreated, kidney disease can lead to kidney failure. If you develop kidney failure, you will need regular dialysis treatments or a kidney transplant to stay alive. Many people with kidney disease also develop heart disease. Early detection and treatment may prevent kidney disease and its complications from getting worse. That is why it is so important for people with HIV to be tested for kidney disease. 4

7 What Are the Symptoms of Kidney Disease? Most people with early kidney disease do not have symptoms. In the later stages of kidney disease, you may: Feel tired or short of breath Have trouble thinking clearly Not feel like eating Have trouble sleeping Have dry, itchy skin Have muscle cramping at night Need to go to the bathroom more often, especially at night Have swollen feet and ankles Have puffiness around your eyes, especially in the morning are people WiTh hiv at GrEaTEr risk for GETTiNG kidney disease? Yes. Having HIV may put you at risk for getting kidney disease. In fact, it is not unusual for people with HIV to develop kidney disease. If you have HIV infection, your chances of getting kidney disease are even greater if you: Have a high viral load (a large amount of HIV in your blood) Have a low CD4 + count (a low number of the blood cells that help fight diseases such as HIV) w w w. k i d n e y. o r g 5

8 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW Are African American, Hispanic American, Asian, Pacific Islander, or American Indian Have diabetes, high blood pressure, or hepatitis C Have a family member who has kidney disease Are 65 or older Have used medications over the course of many years that damage the kidneys Risk factors increase your chance of getting kidney disease. The more risk factors you have, the greater the risk. Tip Anti-inflammatory pain-relieving medicines such as ibuprofen and certain HIV drugs can damage the kidneys. Check with your doctor before taking any medications, including over-the-counter or herbal medicines. Why does hiv put me at GrEaTEr risk for kidney disease? This happens because: HIV can harm the nephrons (filters) in your kidneys. When this happens, the filters do not work as well as they should. HIV can infect the cells in your kidneys. If not carefully monitored, some of the medicines used to treat HIV can harm the nephrons in your kidneys. 6

9 How will I know if I have kidney disease? Most people with early kidney disease do not have symptoms. The best way to find out is to be tested for it. There are three simple tests to check for kidney disease: 1. Urine test Your body needs protein. But it should be in the blood, not the urine. Having a small amount of protein in your urine may mean that your kidneys are not doing their filtering job well enough. This can be an early sign of kidney disease. 2. Blood test Your doctor should test your blood for a waste product called creatinine. Creatinine comes from muscle tissue. When the kidneys are damaged, they have trouble removing creatinine from your blood. The blood test for creatinine will help your doctor find out how well your kidneys are working. But testing creatinine is only the first step. Next, your doctor or lab must use your creatinine result in a math formula with your age, race, and sex to find out your GFR. Your GFR tells your doctor how well your kidneys are working. 3. Regular blood pressure checks Having high blood pressure puts you at risk for kidney disease. Regular blood pressure checks help your doctor find and treat high blood pressure. This helps lessen your risk for kidney damage. w w w. k i d n e y. o r g 7

10 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW how OfTEN ShOuld i be TESTEd for kidney disease? Everyone with HIV should be tested for kidney disease at least once. This should be done when you first learn you have HIV. Ask your health care provider if you were ever tested for kidney disease; if not, get tested. People with HIV who have other risk factors for kidney disease will need to be tested at least once a year. Check to see if you have any of the risk factors listed on pages 5 6. how is kidney disease TrEaTEd? Treatment depends on your stage of kidney disease and other health problems you may have (see page 4 for CKD stages chart). Some patients may be asked to see a kidney doctor (called a nephrologist). A dietitian may be helpful too. Your treatment may include: Medicine for your HIV infection (called antiretroviral therapy) Studies show that controlling HIV can help prevent kidney disease. For most people, more than one HIV drug may be needed to control HIV. Tip Some drugs used in HIV treatment have a lower risk of kidney damage than others. Ask your doctor about HIV drugs with a lower risk of causing kidney damage. 8

11 Medicine for high blood pressure High blood pressure can increase your chances of getting kidney disease or kidney failure. For most people with HIV and kidney disease, blood pressure should be no higher than 125/75. You will probably need a medication called an ACE (angiotensin converting enzyme) inhibitor or an ARB (angiotensin receptor blocker) to control your blood pressure. In many cases, more than one high blood pressure medicine may be needed to reach this target. Protecting kidney function by taking ACE inhibitors or ARBs You may be asked to take high blood pressure medicines (called ACE inhibitors or ARBs) even if your blood pressure is normal. Research suggests that these medicines can slow the loss of kidney function in people with HIV and kidney disease even in people with normal blood pressure. Controlling blood sugar if you have diabetes The best way to prevent or slow kidney damage is to keep your blood sugar controlled. This is usually done with diet, exercise, and, if needed, insulin or pills (called hypoglycemic drugs). Controlling high cholesterol with diet and medication Many people with kidney disease have high cholesterol in the blood. High blood cholesterol increases your risk for heart disease. Your doctor will check your cholesterol at least once a year. If it is too high, you may need drugs and exercise to help lower it. Treating anemia People with kidney disease often get anemia (low red blood cell count). Why does this happen? Healthy kidneys help your body make red blood cells. If you have kidney disease, your kidneys may not be able to do this very well and you may get anemia. Medicines called ESAs (erythropoiesis-stimulating agents) and iron supplements are used to treat anemia. w w w. k i d n e y. o r g 9

12 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW Treating mineral and bone disorders Many people with kidney disease have mineral and bone disorders. Mineral and bone disorders can make your arteries stiffen and become narrow from the extra calcium and phosphorus in your blood. This slows blood flow to your heart and can lead to heart attack and death. You may need special medicines to help prevent and treat mineral and bone disorders. You may also need to eat fewer foods that contain phosphorus, such as dairy, nuts, seeds, dried beans, and peas. Following an exercise program approved by your doctor Controlling your weight with diet and exercise Starting treatment for kidney failure if your kidneys fail WhaT is kidney failure? Kidney failure means your kidneys no longer work well enough to keep you alive. There is no cure for kidney failure. But there are treatments to replace the work of your failed kidneys. how is kidney failure TrEaTEd? There are three possible treatments for kidney failure: Hemodialysis Peritoneal dialysis Kidney transplantation 10

13 Your health care team can discuss these different treatments with you and answer all your questions. If you need treatment for kidney failure, they will help you choose one based on your general health, lifestyle, and treatment preference. What does hemodialysis involve? Hemodialysis is usually done three times a week for several hours each session. It can be done at a dialysis center or at home. In hemodialysis, your blood flows through a machine that has a filter which cleans the blood. This filter is called an artificial kidney or dialyzer. To get your blood into the artificial kidney, two needles are inserted into a vein in your arm during dialysis treatment. A special surgery is required to prepare a suitable vein in the arm to be used for hemodialysis. Hemodialysis is the most common form of treatment for kidney failure. w w w. k i d n e y. o r g 11

14 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW What does peritoneal dialysis involve? Peritoneal dialysis can be done at home, at work, or while traveling. In this type of dialysis, your blood is not cleaned outside the body as with hemodialysis. Instead, fluid and waste products are removed by using your own belly. Here s how it works. A soft tube, called a catheter, is placed inside your belly. This is done by minor surgery. This catheter is the connection that allows a cleansing fluid to flow into your belly. The cleansing fluid is called dialysate. What happens next is an amazing process: the lining of your belly (called the peritoneal membrane) acts as a natural filter; it lets the wastes and extra fluid in your blood pass through it into the cleansing fluid. At the same time, the lining holds back the important things your body needs, like red blood cells and nutrients. Once the filtering process is finished, you drain the used cleansing fluid into an empty bag. You discard the bag and connect a new bag of fluid to begin the cycle again. This bag exchange is usually done four to six times during a 24-hour period. 12

15 CaN a patient WiTh hiv have a kidney TraNSplaNT? Yes. Transplantation is available through clinical trials or as part of routine care at transplant centers across the United States. Your health care provider can give you more information about transplantation. A kidney can come from someone who has died, or from a living person who wishes to donate a kidney. how CaN i lower my ChaNCES for GETTiNG kidney disease? Many people with HIV do not get kidney disease or kidney failure. Talk to your health care provider about your chances of getting kidney disease. If you have HIV, you can lower your chances by: Checking your blood pressure as often as your doctor recommends and taking steps to keep it under control Asking your doctor to test you for kidney disease at least once each year if you: Have a large amount of HIV in your blood Have a low level of blood cells that help fight HIV (CD4 + cells) Are African American, Hispanic American, Asian, Pacific Islander, or American Indian Have diabetes, high blood pressure, or hepatitis C Taking all your HIV medications as prescribed Asking your doctor about HIV drugs that have a lower risk of causing kidney damage Controlling your blood sugar if you have diabetes Taking medicines to control your blood glucose, cholesterol, anemia, and blood pressure if your doctor orders them for you w w w. k i d n e y. o r g 13

16 HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW WhErE CaN i GET more information? To learn more about HIV and chronic kidney disease, contact the National Kidney Foundation (NKF) at or visit You may be interested in asking for a free copy of the following NKF booklets: About Chronic Kidney Disease: A Guide for Patients and Their Families ( ) [Spanish: ] What You Need to Know When You Have Chronic Kidney Disease ( ) GFR (Glomerular Filtration Rate): A Key to Understanding How Well Your Kidneys Are Working ( ) Warning Signs of Kidney and Urinary Tract Disease ( ) Choosing a Treatment for Kidney Failure ( ) Hemodialysis: What You Need to Know ( ) [Spanish: ] Peritoneal Dialysis: What You Need to Know ( ) [Spanish: ] Kidney Transplant ( ) For additional information, check the A-Z Guide on the NKF Web site: National Kidney Foundation (NKF) 30 East 33rd Street New York, NY You may also want to contact: AIDS Info P.O. Box 6303 Rockville, MD

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20 More than 26 million Americans have chronic kidney disease, and most don t even know it. Millions more are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. Through its affiliates and divisions nationwide, the foundation conducts programs in research, professional education, patient and community services, public education, and organ donation. A Curriculum for CKD Risk Reduction and Care 30 East 33 rd Street New York, NY Sponsored by 2008 National Kidney Foundation, Inc. All Rights Reserved