title: Serum albumin and kidney function decline in HIV-infected women.
abstract: BACKGROUND
  Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.
  
  
  METHODS
  The primary predictor was serum albumin concentration.
  
  
  RESULTS
  We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).
  
  
  METHODS
  Kidney function decline was determined by cystatin C-based (eGFR(cys)) and creatinine-based eGFR (eGFR(cr)) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.
  
  
  RESULTS
  After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFR(cys) (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m(2) after adjustment for albuminuria. Results were similar whether using eGFR(cys) or eGFR(cr). In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).
  
  
  CONCLUSIONS
  The cohort is composed of only female participants from urban communities within the United States.
  
  
  CONCLUSIONS
  Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.
authors: School of Medicine, University of California, San Francisco, CA.
authors: Joshua
authors: J
authors: Lang
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
authors: Rebecca
authors: R
authors: Scherzer
authors: School of Medicine, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors: Phyllis C
authors: PC
authors: Tien
authors: Section of Nephrology, Department of Medicine, Yale University, New Haven, CT; Program of Applied Translational Research, Yale University, New Haven, CT.
authors: Chirag R
authors: CR
authors: Parikh
authors: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors: Kathryn
authors: K
authors: Anastos
authors: Department of Medicine, Johns Hopkins University.
authors: Michelle M
authors: MM
authors: Estrella
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Alison G
authors: AG
authors: Abraham
authors: Division of Infectious Diseases, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors: Anjali
authors: A
authors: Sharma
authors: Department of Medicine, Stroger Hospital, Rush University, Chicago, IL; Department of Medicine, Rush University, Chicago, IL.
authors: Mardge H
authors: MH
authors: Cohen
authors: Clinical Immunology Research Laboratory, University of California, Los Angeles, CA.
authors: Anthony W
authors: AW
authors: Butch
authors: University of Southern California, Los Angeles, CA.
authors: Marek
authors: M
authors: Nowicki
authors: School of Medicine, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors: Carl
authors: C
authors: Grunfeld
authors: School of Medicine, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: michael.shlipak@ucsf.edu.
authors: Michael G
authors: MG
authors: Shlipak
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D000328:Adult; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006678:HIV; D006801:Humans; D007677:Kidney Function Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin; D003404:Creatinine
keywords: Albumin; HIV (human immunodeficiency virus); albuminuria; chronic kidney disease (CKD) progression; disease trajectory; incident reduced estimated glomerular filtration rate (eGFR); kidney function