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Urinary biomarkers of kidney injury are associated with all‐cause mortality in the Women's Interagency HIV Study ( WIHS )
Author(s) -
Peralta CA,
Scherzer R,
Grunfeld C,
Abraham A,
Tien PC,
Devarajan P,
Bennett M,
Butch AW,
Anastos K,
Cohen MH,
Nowicki M,
Sharma A,
Young MA,
Sarnak MJ,
Parikh CR,
Shlipak MG
Publication year - 2014
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12113
Subject(s) - medicine , hazard ratio , renal function , lipocalin , creatinine , cystatin c , confidence interval , kidney disease , acute kidney injury , gastroenterology , urinary system
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 (e GFR cys). 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.