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Medium-grade proteinuria is a risk factor for incident markers of chronic kidney disease
S Y Schrader1,2, A J Zeder1,3, R Hilge1,4
1Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.
Objective:
Medium-grade proteinuria (100-500 mg/g creatinine) is common among people living with HIV/AIDS (PLWHA) but is often undetected or ignored. This prospective, observational cohort study examined medium-grade proteinuria as a risk factor for markers of chronic kidney disease (CKD).
Methods:
Quantitative urine samples were collected from 241 PLWHA without known renal disease at baseline between January 2009 and February 2011 and at follow-up 240 weeks later. Multivariate analysis was performed to assess medium-grade proteinuria as a risk factor for incident markers of CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 , albuminuria, phosphaturia).
Results:
Incident markers of CKD were identified in 33 patients (14%), of whom 24 (74%) had medium-grade proteinuria at baseline. Of these, 22 even had proteinuria of < 200 mg/g creatinine. Multivariate analysis showed an adjusted relative risk (aRR) of 2.4 for patients with baseline medium-grade proteinuria to develop signs of CKD. Age was identified as an additional independent predictor. By testing for interaction, tenofovir disoproxil fumarate (TDF)-independent proteinuria was strongly associated with incident CKD markers (aRR = 12.1).
Conclusion:
Medium-grade proteinuria of 100-500 mg/g creatinine is both frequent in PLWHA and a significant risk factor for developing markers of CKD, especially in the absence of TDF. Relevant risk seems to be associated with proteinuria levels as low as 100-200 mg/g creatinine. Current guidelines recommend specific action for proteinuria exceeding 135-200 mg/g but still will miss a relevant number of PLWHA potentially at risk for CKD. An even lower cut-off to trigger nephrological work-up and potentially renoprotective interventions appears to be indicated.
Insights
Medium-grade proteinuria is common in people living with HIV/AIDS (PLWHA) and significantly increases their risk for chronic kidney disease (CKD). Lower detection thresholds for proteinuria are needed to identify at-risk PLWHA for early intervention.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Medium-grade proteinuria (100-500 mg/g creatinine) is prevalent in people living with HIV/AIDS (PLWHA) but often overlooked.
- This condition is a potential risk factor for developing chronic kidney disease (CKD).
Purpose of the Study:
- To investigate medium-grade proteinuria as a risk factor for incident markers of CKD in PLWHA.
- To evaluate the association between proteinuria levels and the development of CKD markers.
Main Methods:
- A prospective, observational cohort study involving 241 PLWHA without prior renal disease.
- Quantitative urine samples collected at baseline and 240 weeks later.
- Multivariate analysis to assess risk factors for CKD markers (eGFR < 60 mL/min/1.73 m², albuminuria, phosphaturia).
Main Results:
- 14% of participants developed incident CKD markers, with 74% having baseline medium-grade proteinuria.
- An adjusted relative risk (aRR) of 2.4 for developing CKD markers was observed in patients with baseline medium-grade proteinuria.
- Proteinuria independent of tenofovir disoproxil fumarate (TDF) showed a strong association with incident CKD markers (aRR = 12.1).
Conclusions:
- Medium-grade proteinuria (100-500 mg/g creatinine) is a frequent and significant risk factor for CKD in PLWHA.
- Risk is evident even at lower proteinuria levels (100-200 mg/g creatinine), particularly when TDF is not a factor.
- Current guidelines may miss at-risk individuals; a lower proteinuria threshold for nephrological evaluation is recommended.
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