Ambulatory urine biomarkers associations with acute kidney injury and hospitalization in people with HIV.

Autor:	Lai M; Kidney Health Research Collaborative, Department of Medicine.; Department of Medicine, University of California San Francisco., Scherzer R; Kidney Health Research Collaborative, Department of Medicine., Shlipak MG; Kidney Health Research Collaborative, Department of Medicine.; Department of Medicine, University of California San Francisco.; San Francisco VA Healthcare System.; Department of Epidemiology and Biostatistics., Madden E; Kidney Health Research Collaborative, Department of Medicine.; San Francisco VA Healthcare System., Vittinghoff E; Kidney Health Research Collaborative, Department of Medicine.; Department of Epidemiology and Biostatistics., Tse W; Kidney Health Research Collaborative, Department of Medicine.; San Francisco VA Healthcare System., Parikh CR; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Villalobos CPC; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Monroy-Trujillo JM; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Moore RD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Estrella MM; Kidney Health Research Collaborative, Department of Medicine.; Department of Medicine, University of California San Francisco.; San Francisco VA Healthcare System.; Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2023 Dec 01; Vol. 37 (15), pp. 2339-2348. Date of Electronic Publication: 2023 Aug 24.
DOI:	10.1097/QAD.0000000000003705
Abstrakt:	Background: People with HIV (PWH) generally have worse ambulatory levels of kidney injury biomarkers and excess risk of acute kidney injury (AKI) compared to persons without HIV. We evaluated whether ambulatory measures of subclinical kidney injury among PWH are associated with subsequent AKI. Methods: In the Predictors of Acute Renal Injury Study (PARIS), which enrolled 468 PWH from April 2016 to August 2019, we measured 10 urine biomarkers of kidney health (albumin, a1m, b2M, NGAL, IL18, KIM-1, EGF, UMOD, MCP-1, YKL40) at baseline and annually during follow-up. Using multivariable Cox regression models, we evaluated baseline and time-updated biomarker associations with the primary outcome of AKI (≥0.3 mg/dl or ≥1.5-times increase in serum creatinine from baseline) and secondary outcome of all-cause hospitalization. Results: At baseline, the mean age was 53 years old, and 45% self-identified as female. In time-updated models adjusting for sociodemographic factors, comorbidities, albuminuria, estimated glomerular filtration rate, and HIV-associated factors, higher KIM-1 [hazard ratio (HR) = 1.30 per twofold higher; 95% confidence interval (CI) 1.03-1.63] and NGAL concentrations (HR = 1.24, 95% CI 1.06-1.44) were associated with higher risk of hospitalized AKI. Additionally, in multivariable, time-updated models, higher levels of KIM-1 (HR = 1.19, 95% CI 1.00, 1.41), NGAL (HR = 1.13, 95% CI 1.01-1.26), and MCP-1 (HR = 1.20, 95% CI 1.00, 1.45) were associated with higher risk of hospitalization. Conclusions: Urine biomarkers of kidney tubular injury, such as KIM-1 and NGAL, are strongly associated with AKI among PWH, and may hold potential for risk stratification of future AKI. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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