Share this article on:

Low-grade proteinuria is highly prevalent in HIV-positive patients on antiretroviral treatment

Gravemann, Sophiab,d,*; Brinkkoetter, Paul T.a,e,*; Vehreschild, Jörg J.b,d; Franke, Berndb; Ehren, Kathrinb; Bünemann, Elisabethb; Orbach, Henningb; Wei, Verena; Hellmich, Martinc; Benzing, Thomasa,e,f,g; Fätkenheuer, Gerdb,d

doi: 10.1097/QAD.0000000000000324
Clinical Science: Concise Communications

Objectives: HIV-positive patients are at an increased risk for chronic kidney disease. However, these data mainly derive from cohorts with a high percentage of African-American patients, representing a specific ethnical risk group for chronic kidney disease. The aim of this study was to estimate the prevalence and risk factors specifically for early signs of kidney dysfunction in a large, predominantly white cohort of HIV patients.

Design: Cross-sectional study.

Methods: Prevalence of low-grade proteinuria was measured by quantitative analysis of urinary protein-to-creatinine ratio (cutoff >70 mg/g) and further differentiated by assessing α1-microglobulin (tubular proteinuria) and albumin-to-creatinine ratio (glomerular proteinuria) of HIV patients attending the University Hospital in Cologne, Germany. Together with standard and HIV-related laboratory findings and medical history, risk factors for each form of proteinuria were identified using multivariate forward selection.

Results: Of 945 enrolled patients, 55% were identified with low-grade proteinuria, 41% with tubular proteinuria, and 20% with glomerular proteinuria. Older age was a risk factor for all forms of proteinuria in multivariate analysis. Low-grade proteinuria was also associated with concomitant diabetes and exposure to nucleoside reverse transcriptase inhibitor [anytime during HIV infection, not tenofovir (TDF)-specific], whereas tubular proteinuria was linked to current and any exposure to nucleoside reverse transcriptase inhibitor (TDF-specific). Further risk factors for glomerular proteinuria were hypertension and diabetes in this cohort.

Conclusion: Low-grade, glomerular and tubular proteinuria are highly prevalent in this large white HIV cohort. Older age represents a nonmodifiable risk factor for all forms of proteinuria. Glomerular proteinuria is associated with modifiable cardiovascular, but not HIV-related risk factors, whereas tubular proteinuria is linked to TDF exposure.

aDepartment II of Internal Medicine

bDepartment I of Internal Medicine, University Hospital of Cologne

cInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne

dGerman Centre for Infection Research (DZIF), Partner Site Bonn-Cologne

eCenter for Molecular Medicine Cologne

fCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD)

gSystems Biology of Ageing Cologne, University of Cologne, Cologne, Germany.

*Dr Sophia Gravemann and Dr Paul T. Brinkkoetter contributed equally to the writing of the article.

Correspondence to Sophia Gravemann, MD, Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Tel: +49 221 478 3324; fax: +49 221 478 88646; e-mail: sophia.gravemann@uk-koeln.de

Received 20 January, 2014

Revised 28 April, 2014

Accepted 29 April, 2014

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).

© 2014 Lippincott Williams & Wilkins, Inc.