title: Factors associated with iohexol-based glomerular filtration rate slope over 36 months in HIV-negative and HIV-positive individuals.
abstract: BACKGROUND
  Monitoring kidney function is important in HIV-positive persons, but creatinine-based estimates of glomerular filtration rate (GFR) have limitations. There are little to no data available assessing GFR trends in HIV-positive persons using a gold-standard measure of GFR.
  
  
  METHODS
  We measured GFR based on iohexol plasma disappearance (iGFR) annually for 3 years in nondiabetic, HIV-negative and HIV-positive volunteers with normal estimated kidney function. We used mixed linear models to evaluate factors associated with baseline iGFR and iGFR slope.
  
  
  RESULTS
  One hundred HIV-negative and 191 HIV-positive, predominantly black individuals (median age 49 years) participated in the study and completed a total of 960 iGFR assessments over a median of 36 months. Despite similar estimated GFR at baseline, average iGFR values were lower in HIV-positive compared with HIV-negative participants (103.2 vs. 110.8, ml/min/1.73 m, P = 0.004). However, subsequent iGFR slope was not significantly different in HIV-positive and HIV-negative participants. In the HIV-positive group, the presence of carotid plaque and hepatitis C virus coinfection were associated with significantly lower iGFR values at baseline. A nonsuppressed HIV RNA level at baseline was associated with a significantly more rapid iGFR decline compared with individuals with HIV RNA less than 400 copies/ml (-4.69 vs. -1.31 ml/min per 1.73 m per year, P = 0.005). Other factors significantly associated with iGFR slope included albuminuria and glycosylated hemoglobin.
  
  
  CONCLUSIONS
  Compared with HIV-negative persons, HIV-positive participants had significantly lower baseline iGFR, despite similar estimated GFR in the two groups. Nonsuppressed HIV RNA at baseline was associated with a more rapid iGFR decline over 3 years.
authors.affiliation: aDepartment of Medicine, Johns Hopkins University School of Medicine bDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland cDepartment of Medicine, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin dDepartment of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
authors.forename: Katie
authors.initials: K
authors.lastname: Zook
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Derek M
authors.initials: DM
authors.lastname: Fine
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
mesh_terms: D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis*; D044967:Serum / Q000737:chemistry
chemical_list: D007472:Iohexol