HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection

Ng, Derek K.a; Jacobson, Lisa P.a; Brown, Todd T.a,b; Palella, Frank J. Jrc; Martinson, Jeremy J.d; Bolan, Roberte; Miller, Edgar R. 3rda,b,f; Schwartz, George J.g; Abraham, Alison G.a; Estrella, Michelle M.b

AIDS:
doi: 10.1097/QAD.0000000000000094
Clinical Science
Abstract

Objective: Diabetes and hypertension, common conditions in antiretroviral-treated HIV-infected individuals, are associated with glomerular hyperfiltration, which precedes the onset of proteinuria and accelerated kidney function decline. In the Multicenter AIDS Cohort Study, we examined the extent to which hyperfiltration is present and associated with metabolic, cardiovascular, HIV and treatment risk factors among HIV-infected men.

Design: Cross-sectional cohort using direct measurement of glomerular filtration rate by iohexol plasma clearance for 367 HIV-infected men and 241 HIV-uninfected men who were free of chronic kidney disease.

Methods: Hyperfiltration was defined as glomerular filtration rate above 140−1 ml/min per 1.73 m2 per year over age 40. Multivariate logistic regression was used to estimate the odds ratios (ORs) of prevalent hyperfiltration for metabolic, cardiovascular, HIV and cumulative antiretroviral exposure factors.

Results: Among individuals without chronic kidney disease, the prevalence of hyperfiltration was higher for HIV-infected participants (25%) compared to uninfected participants (17%; P = 0.01). After adjustment, HIV infection remained associated with hyperfiltration [OR 1.70, 95% confidence interval (CI) 1.11–2.61] and modified the association between diabetes and hyperfiltration, such that the association among HIV-uninfected men (OR 2.56, 95% CI 1.33–5.54) was not observed among HIV-infected men (OR 1.19, 95% CI 0.69–2.05). These associations were independent of known risk factors for hyperfiltration. Indicators of hyperglycemia and hypertension were also associated with hyperfiltration as was cumulative zidovudine exposure.

Conclusion: Hyperfiltration, a potential modifiable predictor of kidney disease progression, is significantly higher among antiretroviral-treated HIV-infected men. Furthermore, HIV-infection nullifies the association of diabetes and hyperfiltration present in HIV-uninfected men.

Author Information

aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health

bDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

cDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

dGraduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania

eLos Angeles Gay and Lesbian Center, Los Angeles, California

fWelch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland

gDepartment of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.

Correspondence to Derek K. Ng, ScM, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E7011, Baltimore, MD 21205, USA. E-mail: dng@jhsph.edu

Received 5 June, 2013

Revised 27 August, 2013

Accepted 19 September, 2013

© 2014 Lippincott Williams & Wilkins, Inc.