Urinary biomarkers of kidney injury are associated with all‐cause mortality in the Women's Interagency HIV Study ( WIHS )
Year: 2013
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Chronic kidney disease (CKD) is common in HIV-infected individuals, and is associated with mortality in both the HIV-infected and general populations. Urinary markers of tubular injury have been associated with future kidney disease risk, but associations with mortality are unknown. METHODS: We evaluated the associations of urinary interleukin-18 (IL-18), liver fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and the albumin-to-creatinine ratio (ACR) with 10-year, all-cause death in 908 HIV-infected women. Serum cystatin C was used to estimate the glomerular filtration rate (eGFRcys). RESULTS: There were 201 deaths during 9269 person-years of follow-up. After demographic adjustment, compared with the lowest tertile, the highest tertiles of IL-18 [hazard ratio (HR) 2.54; 95% confidence interval (CI) 1.75-3.68], KIM-1 (HR 2.04; 95% CI 1.44-2.89), NGAL (HR 1.50; 95% CI 1.05-2.14) and ACR (HR 1.63; 95% CI 1.13-2.36) were associated with higher mortality. After multivariable adjustment including adjustment for eGFRcys, only the highest tertiles of IL-18 (HR 1.88; 95% CI 1.29-2.74) and ACR (HR 1.46; 95% CI 1.01-2.12) remained independently associated with mortality. Findings for KIM-1 were borderline (HR 1.41; 95% CI 0.99-2.02). We found a J-shaped association between L-FABP and mortality. Compared with persons in the lowest tertile, the HR for the middle tertile of L-FABP was 0.67 (95% CI 0.46-0.98) after adjustment. Associations were stronger when IL-18, ACR and L-FABP were simultaneously included in models. CONCLUSIONS: Among HIV-infected women, some urinary markers of tubular injury are associated with mortality risk, independently of eGFRcys and ACR. These markers represent potential tools with which to identify early kidney injury in persons with HIV infection.
Source: HIV Medicine
DOI: 10.1111/hiv.12113
Institutions: San Francisco VA Medical Center, University of California, San Francisco, Johns Hopkins University, Cincinnati Children's Hospital Medical Center, University of California, Los Angeles, Albert Einstein College of Medicine, Rush University Medical Center, University of Southern California, SUNY Downstate Health Sciences University, Georgetown University Medical Center, Tufts Medical Center, Yale University
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Veterans Affairs, Northern California Institute for Research and Education, National Institutes of Health, University of California, San Francisco, National Institute on Aging, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, National Center for Research Resources, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1252706584, G1383752764, G1423343497, G1440661678, Clinical and Translational Science Institute, G1653728403, G1689765846, G1919789535, G2037985070, G2210861095, G2567544100, G2574405597, G2674972404, G2692709432, G3009646583, G316338625, G3212103026, G3222910550, G3264576717, G3322721267, The Connie Wofsy Women's HIV Study, Racial/Ethnic Disparities in Kidney Function Decline: Genes or Environment?, Brooklyn Women's Interagency HIV Study (WIHS) V, G3658850503, G3901006228, G398667773, G4097647764, G4210511483, G4419450409, WIHS Data Management and Analysis Center (WDMAC), G4547062945, G4622231416, Southern California Women's Interagency HIV Study Consortium, G499585988, Chicago WIHS Consortium V (CWC), G5182092287, Critical Translational Studies in Pediatric Nephrology, G5282551706, Washington Women's Interagency HIV/AIDS Study, Clinical and Translational Science Institute, G6295786800, G6540687201, G6694807131, G7195401492, G758528517, Women's Interagency HIV Study (WIHS-V), G8121648955, G826976987, G8350406629, G893076474, G8962527242, G8964979204, G9000034972, G9000058261, G9000073987, G9000237332, G9000338758, Biomarker-Based Diagnostic Algorithms To Prevent, Detect And Guide Treatment Of Kidney Disease In Persons Living With HIV, UCSF-Bay Area Center for AIDS Research, G90347297, G920507375, G925273713, G937853209, G976727283
OpenAlex ID: W2100909666