Chronic kidney disease risk factors were associated with specific patterns of changes in urine biomarker levels in patients with HIV, which suggests routine measurement of these levels may be beneficial in both identifying early kidney injury and stopping its progression to CKD, according to a study published in BMC Nephrology.
“HIV-positive persons bear an excess burden of CKD; however, conventional methods to assess kidney health are insensitive and non-specific for detecting early kidney injury,” Anthony N. Muiru, MD, of the Kidney Health Research Collaborative, department of medicine, San Francisco Veterans Affairs Medical Center and University of California, and colleagues wrote. “Urinary biomarkers can detect early kidney injury and may help mitigate the risk of overt CKD.”
To determine if CKD risk factors had particular patterns of kidney injury that were also associated with unique sets of urinary biomarkers, researchers conducted a cross-sectional study of 198 adults with HIV from the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study (mean age, 48 years; 64% were black; 56% were women; median eGFR, 103 ml/min/1.73 m2).
Levels of 14 urine biomarkers were measured to capture multiple and distinct dimensions of kidney injury. Researchers then used separate multivariable adjusted models to evaluate the associations of known CKD risk factors — including age, race, cigarette use, diabetes, hypertension, HCV co-infection, plasma HIV-1 RNA and CD4+ count — with each of the urine biomarkers.
Researchers found distinct patterns of risk factors that were associated with each biomarker and that these associations varied in magnitude.
More specifically, it was observed that HIV viral load was mainly associated with elevations in interleukin-18 and albuminuria and that higher CD4 levels were associated with lower monocyte chemoattractant protein-1 (MPC-1)and beta 2-microglobulin.
Researchers also observed that older age was significantly associated with elevations in alpha 1-microglobulin, kidney injury marker-1, clusterin, MCP-1, chitinase-3-like protein-1 levels, lower epidermal growth factor and uromodulin levels.
“We have shown that each known CKD risk factor is associated with a distinct pattern of changes in urine biomarker levels,” the researchers wrote. “While our findings highlight the potential clinical utility of routine measurement of multiple biomarker levels, our findings require validation in larger, more diverse patient populations. Evaluation of the predictive performance of biomarker measurement in the patient populations described herein address a necessary step in the ascertainment of the potential value of urinary biomarker level measurement for use in broader clinical settings.”
By Melissa J. Webb