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Abstract: PO2253

Associations of CKD Risk Factors and Longitudinal Changes in Urine Biomarkers of Kidney Tubules Among Women Living with HIV

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
  • Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States
  • Ascher, Simon, University of California Davis Department of Internal Medicine, Sacramento, California, United States
  • Jotwani, Vasantha, University of California San Francisco, San Francisco, California, United States
  • Ng, Derek, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Gustafson, Deborah, SUNY The State University of New York, Albany, New York, United States
  • Spence, Amanda Blair, Georgetown University, Washington, District of Columbia, United States
  • Parikh, Chirag R., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Sharma, Anjali, Albert Einstein College of Medicine, Bronx, New York, United States
  • Ix, Joachim H., University of California San Diego School of Medicine, La Jolla, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
Background

Among women with HIV (WWH), urine biomarkers of tubule dysfunction and injury allow detection of antiretroviral toxicity and prediction of CKD risk and mortality. However, risk factors for changes in urine biomarkers are unclear.

Methods

We assessed traditional and infection-related CKD risk factors and measured 14 urine biomarkers at baseline and at follow-up (median 2.5 years) among WWH in the Women’s Interagency HIV Study. We used simultaneously adjusted multivariable linear regression models to evaluate the associations of CKD risk factors with changes in biomarker levels concurrently.

Results

Of the 647 women in this analysis, 67% were Black, median age at baseline was 45 years and eGFR was 104 ml/min/1.73m2. Each CKD risk factor associated with distinct changes in urine biomarkers (Figure). For example, baseline hemoglobin a1c (HbA1c) associated with worse tubular injury (higher interleukin-18 [IL-18]), proximal tubular reabsorptive dysfunction (higher alpha-1 microglobulin), tubular reserve (lower umodulin) and heightened immune response to injury (higher chitinase-3-like protein [YKL-40]). Higher HbA1c at follow-up was associated with further worsening of tubular injury (higher kidney injury molecule-1 [KIM-1] and IL-18), and immune response to injury (higher YKL-40). Hepatitis C virus co-infection associated with worsening proximal tubular reabsorptive dysfunction (higher beta-2 microglublin [β2m]), and immune response to injury (higher YKL-40), whereas HIV viremia associated with worsening markers of tubular and glomerular injury (higher KIM-1 and albumin, respectively).

Conclusion

CKD risk factors associated with unique patterns of biomarker changes among WWH, suggesting that longitudinal biomarker measurements may help in detecting and monitoring kidney disease in WWH.

Showing 7 risk factors and 8 biomarkers selected based on prior literature.

Funding

  • NIDDK Support