HIV and Opportunistic Infections, Coinfections, and Conditions

HIV and Kidney Disease

Last Reviewed: March 31, 2025

Key Points

  • The kidneys, two fist-sized organs positioned just below the ribcage on either side of the spine, filter waste and excess water from the blood.
  • Injury and disease, including high blood pressure, diabetes, and HIV can harm the kidneys and lead to kidney disease. The risk of kidney disease increases with poorly controlled HIV, especially with hepatitis C virus (HCV) coinfection.
  • 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 treatment regimen.
  • Kidney disease can advance to kidney failure, which is treated with dialysis and kidney transplant in people with and without HIV.

 

What are the kidneys and what do they do?

The kidneys are two fist-sized organs in the body. They are located beneath the ribcage on both sides 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 damage the kidneys. Damage to the kidneys can lead to kidney disease (also called renal disease). Kidney disease can advance to kidney failure, which is known as end-stage renal disease.

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.

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

The risk of kidney failure is especially high among African Americans, Hispanics, and American Indians, partially because these communities have high rates of diabetes and high blood pressure.

Are people with HIV at risk for kidney disease?

In addition to the risk factors listed above, there is an increased risk of kidney disease in people with poorly controlled HIV as well as those with HIV and hepatitis C virus (HCV) coinfection.

Antiretroviral therapy (ART) refers to the use of HIV medicines to treat HIV, which is often a combination of HIV medicines (called an HIV treatment regimen) that are taken every day (pills) or by schedule (injections). HIV medicines are recommended for everyone who has HIV; however, 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 treatment regimen. If a person with HIV shows signs of kidney disease, their health care provider may adjust the dose of their HIV medicines or change which HIV medicines are included in their treatment regimen.

What are the symptoms of kidney disease?

Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease.

As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles (called edema). Symptoms of advanced chronic kidney disease can include:

  • Increased or decreased urination
  • Feeling tired or having trouble sleeping
  • Nausea and vomiting
  • Itching or numbness

Blood and urine tests are used to detect kidney disease, which should be prioritized in people with HIV.

What is the treatment for kidney disease?

People with kidney disease can take steps to protect their kidneys from further damage. For example, many people with kidney disease take medicines to control high blood pressure. They may also reduce the amount of certain nutrients in their diet (such as salt and protein) to help manage their kidney disease.

Some people live with kidney disease for many years; in others, kidney disease progresses to kidney failure. The treatments for kidney failure are dialysis and kidney transplant. Both treatments take over the job of the failed kidneys.

  • Dialysis: There are two main types of dialysis. Both types, like the kidneys, filter harmful waste and extra water out of the blood. In hemodialysis, a machine outside of the body is used to filter the blood. In peritoneal dialysis, the lining of the abdomen filters the blood inside the body using a catheter.
  • Transplant: A kidney transplant is a surgery that replaces a failing kidney with a healthy kidney from a donor. The donated kidney can be from a person who recently died or from a living person.

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

How can people with HIV reduce their risk of kidney disease?

People with HIV can take the following steps to reduce their risk of kidney disease:

  • Take HIV medicines as prescribed to keep HIV under control.
  • Eat a healthy diet that includes fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Cut back on foods high in salt and sugar.
  • Be physically active for at least 30 minutes on most days.
  • Keep all medical appointments, including those for blood and urine tests that may screen for kidney function.
  • During medical visits, talk to a health care provider about the risk of kidney disease and if you believe you are experiencing signs of kidney disease.

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

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

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

Also see the HIV Source collection of HIV links and resources.