TY - JOUR
T1 - Association of urineα1-microglobulin with kidney function decline and mortality in HIV-infected women
AU - Jotwani, Vasantha
AU - Scherzer, Rebecca
AU - Abraham, Alison
AU - Estrella, Michelle M.
AU - Bennett, Michael
AU - Cohen, Mardge H.
AU - Nowicki, Marek
AU - Sharma, Anjali
AU - Young, Mary
AU - Tien, Phyllis C.
AU - Ix, Joachim H.
AU - Sarnak, Mark J.
AU - Parikh, Chirag R.
AU - Shlipak, Michael G.
N1 - Publisher Copyright:
© 2015 by the American Society of Nephrology.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
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U2 - 10.2215/CJN.03220314
DO - 10.2215/CJN.03220314
M3 - Article
C2 - 25370597
AN - SCOPUS:84923924890
SN - 1555-9041
VL - 10
SP - 63
EP - 73
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 1
ER -