HIV and Kidney Disease

What Are the Kidneys and What Do They Do?

The kidneys are two fist-sized organs in the body. They are located near the middle of the back on either side of the spine.

The main job of the kidneys is to filter harmful waste and extra water from the blood. The waste and water become urine, which is flushed from the body. The kidneys also release hormones that help control blood pressure, make red blood cells, and keep bones strong.

Kidney function declines as people age. Injury or disease, including HIV infection, can also damage the kidneys. Damage to the kidneys can lead to kidney disease (also called renal disease). Kidney disease can advance to kidney failure.

What Are the Causes of Kidney Disease?

Diabetes and high blood pressure are the leading causes of kidney disease. Other factors that increase the risk of kidney disease include heart disease and a family history of kidney disease or kidney failure.

A person's risk of kidney disease increases as they get older. The longer a person has diabetes, high blood pressure, or heart disease, the greater their risk of kidney disease.

Anyone can get kidney disease, but the risk is greatest for African Americans, Hispanics, and American Indians, mainly because of the high rates of high blood pressure and diabetes among these population groups.

Are People With HIV at Risk for Kidney Disease?

The risk factors for kidney disease in people with HIV include all those listed above. In addition, poorly controlled HIV infection and coinfection with the hepatitis C virus (HCV) increase the risk of kidney disease in people with HIV.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines (called an HIV regimen) every day. ART is recommended for everyone who has HIV. Some HIV medicines can affect the kidneys. Health care providers carefully consider the risk of kidney damage when recommending specific HIV medicines to include in an HIV regimen. If a person on ART shows signs of kidney disease, the type or dose of HIV medicine in their HIV regimen may change.

What Are the Symptoms of Kidney Disease?

Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease. Chronic kidney disease may not cause symptoms for many years.

Sudden damage to the kidneys, often because of an illness or injury, is called acute kidney injury.

Symptoms of worsening kidney disease can include:

• Swelling of the legs, feet, or ankles (called edema)
• Increased or decreased urination
• Feeling tired or having trouble sleeping
• Nausea and vomiting
• Itching or numbness

Blood and urine tests are often the only way to detect kidney disease. Care for people with HIV includes testing for kidney disease.

What Is the Treatment for Kidney Disease?

People with kidney disease often take medicines to slow down the disease and delay kidney failure. They may also change what they eat and drink to manage their kidney disease. For example, they may need to reduce the amount of salt and protein in their diet.

The treatments for kidney failure are dialysis and a kidney transplant. Both treatments take over the job of the failed kidneys.

• There are two types of dialysis. In hemodialysis, a machine filters harmful waste and extra water out of the blood. In peritoneal dialysis, the lining of the abdomen acts as the filter.
• A kidney transplant is surgery to place a healthy kidney from a donor into the body of a person with kidney disease. The donated kidney can be from a person who just died or from a living person.

Both dialysis and a kidney transplant are used to treat kidney failure in people with HIV.

I Am Living With HIV. How Can I Reduce My Risk of Kidney Disease?

Take the following steps to reduce your risk of kidney disease:

• Take your HIV medicines every day to keep your HIV under control.
• Eat a healthy diet that includes fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods. Avoid processed foods high in salt, such as deli meats, soups, and chips.
• Make physical activity a part of every day.
• Keep all of your medical appointments. During your visits, talk to your health care provider about your risk for kidney disease.

This fact sheet is based on information from the following sources:

From the Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:

• Initiation of Antiretroviral Therapy
• Considerations for Antiretroviral Use in Special Patient Populations: HIV and the Older Patient
• Appendix B: Drug Characteristics Tables: Table 7. Antiretroviral Dosing Recommendations in Patients with Renal or Hepatic Insufficiency

From the U.S. Department of Veterans Affairs:

• Renal Disease and HIV

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Your Kidneys and How They Work
• Race, Ethnicity, & Kidney Disease 
• Chronic Kidney Disease (CKD)
• Kidney Failure

[Note from TheBody.com: This article was originally published by AIDSinfo on June 18, 2017. We have cross-posted it with their permission.]