A Needs Assessment of HIV Providers in the Evaluation of Kidney Function in People Living with HIV

Background: Kidney disease is common in people living with HIV (PLHIV). Unique factors in HIV, including sarcopenia and certain antiretroviral drugs, can make creatinine unreliable. HIV providers are often the primary healthcare resource for PLHIV and the recognition of kidney disease lies in their hands. Methods: We conducted a pilot survey of HIV providers in the University of Pennsylvania Health System. Questions focused on (1) current clinical practices for kidney function assessment, (2) identifying knowledge and attitudes for best clinical practices for kidney function assessment, and (3) identifying care gaps in the management of PLHIV. Results: A total of 22 providers responded to the survey, including 16 physicians, 2 infectious disease pharmacists, 1 advanced practitioner. For routine care of PLHIV, most providers assess kidney function with a serum creatinine and urinalysis (95% and 68%, respectively). For PLHIV with an elevated creatinine, 95% of providers (n=21) would obtain a repeat creatinine. Only 23% (n=5) would obtain a cystatin C. To determine drug dosing, 32% of providers (n=7) use an estimated GFR (eGFR) equation, 9% (n=2) use Cockcroft Gault creatinine clearance, and 14% (n=3) use serum creatinine. Nearly half of providers (n=10, 45%) responded “I am not sure”. Only 18% of providers (n=4) felt comfortable with the use of cystatin C. There was variable practice in nephrology referral, with 41% of providers (n=9) referring at an eGFR<60mL/min/1.73m2 and 21% (n=5) at 45mL/min/1.73m2. Only 21% (n=5) waited until the KDIGO guideline of 30mL/min/1.73m2. Conclusion: In this pilot survey, HIV providers reported high uncertainty regarding kidney function measurement and the identification of kidney disease. HIV providers may benefit from targeted education to reduce medication errors related to drug dosing as well as appropriate nephrology referrals. Funding: NIDDK Support