Association of urineα1-microglobulin with kidney function decline and mortality in HIV-infected women

Vasantha Jotwani, Rebecca Scherzer, Alison Abraham, Michelle M. Estrella, Michael Bennett, Mardge H. Cohen, Marek Nowicki, Anjali Sharma, Mary Young, Phyllis C. Tien, Joachim H. Ix, Mark J. Sarnak, Chirag R. Parikh, Michael G. Shlipak

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background and objectivesDespite advances in therapy, HIV-infected individuals remain at higher risk for kidney dysfunction than uninfected individuals. It was hypothesized that urine levels ofα1-microglobulin, a biomarker of proximal tubular dysfunction, would predict kidney function decline and mortality risk in HIV-infected and uninfected women. Design, setting, participants, & measurementsIn the Women’s Interagency HIV Study, urineα1-microglobulin and creatinine concentrations were measured in 903 HIV-infected and 287 uninfected women using stored urine from 1999 to 2000, when prevalence of tenofovir use was <1%. Participants were categorized into three categories by level ofα1-microglobulin–to-creatinine ratio, and associations with kidney decline and all-cause mortality over 8 years were evaluated. ResultsUrineα1-microglobulin was detectable in 60% of HIV-infected and 40% of uninfected women (P<0.001). Among HIV-infected women, there were 177 (22%), 61 (7%), and 128 (14%) patients with incident CKD, with 10% annual eGFR decline, and who died, respectively. Compared with HIV-infected women in the lowestα1-microglobulin category, HIV-infected women in the highestα1-microglobulin category had a 2.1-fold risk of incident CKD (95% confidence interval, 1.3 to 3.4), 2.7-fold risk of 10% annual eGFR decline (95% confidence interval, 1.2 to 5.9), and 1.6-fold mortality risk (95% confidence interval, 1.0 to 2.6) in models adjusting for kidney risk factors, baseline eGFR, and albuminuria. Among uninfected women, the highestα1-microglobulin category was associated with 3% (relative risk, 2.2; 95% confidence interval, 1.4 to 3.5) and 5% (relative risk, 2.2; 95% confidence interval, 1.1 to 4.3) annual eGFR decline relative to the lowestα1-microglobulin category ConclusionsProximal tubular dysfunction, indicated by urineα1-microglobulin, was independently associated with kidney function decline in HIV-infected and uninfected women and mortality risk among HIV-infected women.

Original languageEnglish (US)
Pages (from-to)63-73
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Jotwani, V., Scherzer, R., Abraham, A., Estrella, M. M., Bennett, M., Cohen, M. H., Nowicki, M., Sharma, A., Young, M., Tien, P. C., Ix, J. H., Sarnak, M. J., Parikh, C. R., & Shlipak, M. G. (2015). Association of urineα1-microglobulin with kidney function decline and mortality in HIV-infected women. Clinical Journal of the American Society of Nephrology, 10(1), 63-73. https://doi.org/10.2215/CJN.03220314