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, & 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 <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<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.
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, & 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 <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<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.
Authors: Rebecca Scherzer; Michelle Estrella; Yongmei Li; Andy I Choi; Steven G Deeks; Carl Grunfeld; Michael G Shlipak Journal: AIDS Date: 2012-04-24 Impact factor: 4.177
Authors: Michael G Shlipak; Rebecca Scherzer; Alison Abraham; Phyllis C Tien; Carl Grunfeld; Carmen A Peralta; Prasad Devarajan; Michael Bennett; Anthony W Butch; Kathryn Anastos; Mardge H Cohen; Marek Nowicki; Anjali Sharma; Mary A Young; Mark J Sarnak; Chirag R Parikh Journal: J Acquir Immune Defic Syndr Date: 2012-12-15 Impact factor: 3.731
Authors: Leal C Herlitz; Sumit Mohan; Michael B Stokes; Jai Radhakrishnan; Vivette D D'Agati; Glen S Markowitz Journal: Kidney Int Date: 2010-09-01 Impact factor: 10.612
Authors: Saskia M E Vrouenraets; Christoph A Fux; Ferdinand W N M Wit; Evian Fernandez Garcia; Hansjakob Furrer; Kees Brinkman; Frans J Hoek; Nico G G M Abeling; Ray T Krediet; Peter Reiss Journal: AIDS Date: 2011-11-13 Impact factor: 4.177
Authors: Lesley A Inker; John Eckfeldt; Andrew S Levey; Catherine Leiendecker-Foster; Gregory Rynders; Jane Manzi; Salman Waheed; Josef Coresh Journal: Am J Kidney Dis Date: 2011-08-19 Impact factor: 8.860
Authors: Todd H Driver; Rebecca Scherzer; Carmen A Peralta; Phyllis C Tien; Michelle M Estrella; Chirag R Parikh; Anthony W Butch; Kathryn Anastos; Mardge H Cohen; Marek Nowicki; Anjali Sharma; Mary A Young; Alison Abraham; Michael G Shlipak Journal: AIDS Date: 2013-09-10 Impact factor: 4.177
Authors: Simon B Ascher; Rebecca Scherzer; Michelle M Estrella; Michael G Shlipak; Derek K Ng; Frank J Palella; Mallory D Witt; Ken Ho; Michael R Bennett; Chirag R Parikh; Joachim H Ix; Vasantha Jotwani Journal: Am J Nephrol Date: 2019-09-25 Impact factor: 3.754
Authors: Vasantha Jotwani; Rebecca Scherzer; David V Glidden; Megha Mehrotra; Patricia Defechereux; Albert Liu; Monica Gandhi; Michael Bennett; Steven G Coca; Chirag R Parikh; Robert M Grant; Michael G Shlipak Journal: J Acquir Immune Defic Syndr Date: 2018-06-01 Impact factor: 3.731
Authors: Simon B Ascher; Rebecca Scherzer; Arvind Nishtala; Vasantha Jotwani; Carl Grunfeld; Chirag R Parikh; Derek Ng; Ruibin Wang; Frank J Palella; Michael G Shlipak; Michelle M Estrella Journal: J Acquir Immune Defic Syndr Date: 2019-10-01 Impact factor: 3.731
Authors: Simon B Ascher; Rebecca Scherzer; Carmen A Peralta; Phyllis C Tien; Carl Grunfeld; Michelle M Estrella; Alison Abraham; Deborah R Gustafson; Marek Nowicki; Anjali Sharma; Mardge H Cohen; Anthony W Butch; Mary A Young; Michael R Bennett; Michael G Shlipak Journal: Hypertension Date: 2016-12-19 Impact factor: 10.190
Authors: Eric C Tang; Eric Vittinghoff; Peter L Anderson; Stephanie E Cohen; Susanne Doblecki-Lewis; Oliver Bacon; Megan E Coleman; Susan P Buchbinder; Wairimu Chege; Michael A Kolber; Richard Elion; Michael Shlipak; Albert Y Liu Journal: J Acquir Immune Defic Syndr Date: 2018-02-01 Impact factor: 3.731
Authors: Vasantha Jotwani; Rebecca Scherzer; Michelle M Estrella; Lisa P Jacobson; Mallory D Witt; Frank J Palella; Bernard Macatangay; Michael Bennett; Chirag R Parikh; Joachim H Ix; Michael G Shlipak Journal: Am J Kidney Dis Date: 2016-06-08 Impact factor: 8.860
Authors: Rakesh Malhotra; Timothy Craven; Walter T Ambrosius; Anthony A Killeen; William E Haley; Alfred K Cheung; Michel Chonchol; Mark Sarnak; Chirag R Parikh; Michael G Shlipak; Joachim H Ix Journal: Am J Kidney Dis Date: 2018-10-02 Impact factor: 8.860