P-220. A Needs Assessment of HIV Clinicians in the Evaluation and Initial Management of Kidney Dysfunction Among People Living with HIV: Results from a Cross-Sectional Survey

TL;DR

This study surveyed HIV clinicians about how they assess and manage kidney dysfunction in people living with HIV, finding widespread uncertainty and variability in practices.

Contribution

The study provides new insights into clinical practices and knowledge gaps among HIV providers in evaluating kidney function.

Findings

Most HIV providers use serum creatinine and urinalysis for kidney function assessment.

Only a small percentage use cystatin C or are confident in incorporating it into eGFR assessments.

There is significant variability in when providers refer patients to nephrology based on eGFR thresholds.

Abstract

Kidney disease is common among people living with HIV (PLHIV). Unique factors associated with HIV, such as sarcopenia and the use of certain antiretroviral therapies, can compromise the accuracy of measurements of kidney function. As primary healthcare providers for many PLHIV, HIV clinicians play a critical role in recognizing and managing kidney disease.

Survey Questions

We distributed an electronic survey to HIV providers via members and/or credentialees of the American Academy of HIV Medicine through a weekly newsletter and two standalone emails sent out biweekly from April 3, 2025 to April 28, 2025. Questions focused on (1) current clinical practices for kidney function assessment, (2) knowledge and attitudes for best clinical practices for kidney function assessment, and (3) identifying care gaps in the management of PLHIV.

A total of 150 providers responded to the survey, including 58 (39%) physicians, 27 (18%) infectious disease pharmacists, 42 (28%) nurse practitioners, and 16 (11%) physician assistants. For routine care of PLHIV, most providers assess kidney function with serum creatinine and urinalysis (96% and 61%, respectively). For PLHIV with an elevated creatinine, 75% of providers (n=112) repeat a serum creatinine, 69% (n=103) measure urine albumin or protein, and 60% (n=90) obtain a urinalysis. Only 25% (n=38) obtain a cystatin C. For drug dosing decisions, 21% of providers (n=31) use Cockcroft Gault creatinine clearance equation, 44% (n=66) use an estimated GFR (eGFR) equation, and 33% (n=50) use both. Among those using an eGFR equation, 37% (n=43) were unsure whether to use the MDRD or CKD-EPI. Only 22% (n=33) of providers felt comfortable incorporating cystatin C into eGFR assessment. There was variable practice in nephrology referral. Of the 115 of providers who refer to nephrology for reduced eGFR, 13% (n=15) referring at an eGFR< 60mL/min/1.73m2 and 53% (n=61) at 45mL/min/1.73m2. Only 30% (n=34) waited until 30mL/min/1.73m2.

In this survey, HIV providers reported high rates of uncertainty regarding evaluation of elevated creatinine and GFR assessment. Targeted educational intervention to reduce medication errors related to drug dosing as well as appropriate referrals to nephrology

Amanda Binkley, PharmD, BCIDP, AAHIVP, Shionogi: Advisor/Consultant William R. Short, MD, Gilead Sciences: Grant/Research Support|ViiV: Advisor/Consultant

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