1
Figure 1. Chronic Kidney Disease Classification According to
Glomerular Filtration Rate and Albuminuria Strata
Î IDSA recommends that HIV-infected patients with kidney disease be
referred to a nephrologist for diagnostic evaluation when there is a
clinically significant decline in GFR (ie, GFR decline by >25% from
baseline and to a level <60 mL/minute/1.73 m
2
) that fails to resolve
after potential nephrotoxic drugs are removed, there is albuminuria
in excess of 300 mg per day, hematuria is combined with either
albuminuria/proteinuria or increasing blood pressure, or for advanced
CKD management (GFR <30 mL/minute/1.73 m
2
) (S-L).
Î When possible, IDSA recommends establishing permanent dialysis
access, ideally an arteriovenous fistula or peritoneal catheter, prior to
the anticipated start of renal replacement therapy to avoid the use of
higher-risk central venous catheters for hemodialysis (HD) (S-M).
Î When possible, IDSA recommends avoiding the use of peripherally
inserted central catheters and subclavian central venous catheters
in patients with HIV who are anticipated to need dialysis in the
future because these devices can damage veins and limit options for
permanent HD access (S-M).
Diagnosis
e colors reflect degree of risk for clinical outcomes including end-stage renal disease, cardiovascular
events and related mortality, and all-cause mortality. Green represents low risk, yellow is moderately
increased risk, orange is high risk, and red is very high risk.
Adapted from the Kidney Disease: Improving Global Outcomes Guidelines (KDIGO) Chronic
Kidney Disease Work Group. Kidney Int Suppl. 2013;3:1-150.
