RT Journal Article
SR Electronic
T1 Association of Urine <em>α</em>1-Microglobulin with Kidney Function Decline and Mortality in HIV-Infected Women
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 63
OP 73
DO 10.2215/CJN.03220314
VO 10
IS 1
A1 Jotwani, Vasantha
A1 Scherzer, Rebecca
A1 Abraham, Alison
A1 Estrella, Michelle M.
A1 Bennett, Michael
A1 Cohen, Mardge H.
A1 Nowicki, Marek
A1 Sharma, Anjali
A1 Young, Mary
A1 Tien, Phyllis C.
A1 Ix, Joachim H.
A1 Sarnak, Mark J.
A1 Parikh, Chirag R.
A1 Shlipak, Michael G.
YR 2015
UL http://cjasn.asnjournals.org/content/10/1/63.abstract
AB Background and objectives Despite advances in therapy, HIV-infected individuals remain at higher risk for kidney dysfunction than uninfected individuals. It was hypothesized that urine levels of α1-microglobulin, a biomarker of proximal tubular dysfunction, would predict kidney function decline and mortality risk in HIV-infected and uninfected women.Design, setting, participants, &amp; measurements In the Women’s Interagency HIV Study, urine α1-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 &lt;1%. Participants were categorized into three categories by level of α1-microglobulin–to-creatinine ratio, and associations with kidney decline and all-cause mortality over 8 years were evaluated.Results Urine α1-microglobulin was detectable in 60% of HIV-infected and 40% of uninfected women (P&lt;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 lowest α1-microglobulin category, HIV-infected women in the highest α1-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 highest α1-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 lowest α1-microglobulin category.Conclusions Proximal tubular dysfunction, indicated by urine α1-microglobulin, was independently associated with kidney function decline in HIV-infected and uninfected women and mortality risk among HIV-infected women.