Low-grade proteinuria is highly prevalent in HIV-positive patients on antiretroviral treatment.
OBJECTIVE
HIV-positive patients are at an increased risk for chronic kidney disease. However, these data mainly derive from cohorts with a high percentage of African-American patients, representing a specific ethnical risk group for chronic kidney disease. The aim of this study was to estimate the prevalence and risk factors specifically for early signs of kidney dysfunction in a large, predominantly white cohort of HIV patients.


METHODS
Cross-sectional study.


METHODS
Prevalence of low-grade proteinuria was measured by quantitative analysis of urinary protein-to-creatinine ratio (cutoff >70 mg/g) and further differentiated by assessing α1-microglobulin (tubular proteinuria) and albumin-to-creatinine ratio (glomerular proteinuria) of HIV patients attending the University Hospital in Cologne, Germany. Together with standard and HIV-related laboratory findings and medical history, risk factors for each form of proteinuria were identified using multivariate forward selection.


RESULTS
Of 945 enrolled patients, 55% were identified with low-grade proteinuria, 41% with tubular proteinuria, and 20% with glomerular proteinuria. Older age was a risk factor for all forms of proteinuria in multivariate analysis. Low-grade proteinuria was also associated with concomitant diabetes and exposure to nucleoside reverse transcriptase inhibitor [anytime during HIV infection, not tenofovir (TDF)-specific], whereas tubular proteinuria was linked to current and any exposure to nucleoside reverse transcriptase inhibitor (TDF-specific). Further risk factors for glomerular proteinuria were hypertension and diabetes in this cohort.


CONCLUSIONS
Low-grade, glomerular and tubular proteinuria are highly prevalent in this large white HIV cohort. Older age represents a nonmodifiable risk factor for all forms of proteinuria. Glomerular proteinuria is associated with modifiable cardiovascular, but not HIV-related risk factors, whereas tubular proteinuria is linked to TDF exposure.
aDepartment II of Internal Medicine bDepartment I of Internal Medicine, University Hospital of Cologne cInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne dGerman Centre for Infection Research (DZIF), Partner Site Bonn-Cologne eCenter for Molecular Medicine Cologne fCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) gSystems Biology of Ageing Cologne, University of Cologne, Cologne, Germany. *Dr Sophia Gravemann and Dr Paul T. Brinkkoetter contributed equally to the writing of the article.
Sophia
S
Gravemann
Paul T
PT
Brinkkoetter
Jörg J
JJ
Vehreschild
Bernd
B
Franke
Kathrin
K
Ehren
Elisabeth
E
Bünemann
Henning
H
Orbach
Verena
V
Weiß
Martin
M
Hellmich
Thomas
T
Benzing
Gerd
G
Fätkenheuer
D000328:Adult; D000368:Aged; D000418:Albumins / Q000032:analysis; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria / Q000175:diagnosis* / Q000473:pathology*; D012307:Risk Factors; D014556:Urine / Q000737:chemistry; D000511:alpha-Macroglobulins / Q000652:urine
D000418:Albumins; D044966:Anti-Retroviral Agents; D000511:alpha-Macroglobulins