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Am J Kidney Dis. 2014 Oct;64(4):584-91. doi: 10.1053/j.ajkd.2014.05.015. Epub 2014 Jul 22.

Serum albumin and kidney function decline in HIV-infected women.

Author information

1
School of Medicine, University of California, San Francisco, CA.
2
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
3
School of Medicine, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
4
Section of Nephrology, Department of Medicine, Yale University, New Haven, CT; Program of Applied Translational Research, Yale University, New Haven, CT.
5
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
6
Department of Medicine, Johns Hopkins University.
7
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
8
Division of Infectious Diseases, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
9
Department of Medicine, Stroger Hospital, Rush University, Chicago, IL; Department of Medicine, Rush University, Chicago, IL.
10
Clinical Immunology Research Laboratory, University of California, Los Angeles, CA.
11
University of Southern California, Los Angeles, CA.
12
School of Medicine, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: michael.shlipak@ucsf.edu.

Abstract

BACKGROUND:

Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.

STUDY DESIGN:

Retrospective cohort analysis.

SETTING & PARTICIPANTS:

Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.

PREDICTOR:

The primary predictor was serum albumin concentration.

OUTCOMES:

We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).

MEASUREMENTS:

Kidney function decline was determined by cystatin C-based (eGFR(cys)) and creatinine-based eGFR (eGFR(cr)) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.

RESULTS:

After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFR(cys) (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m(2) after adjustment for albuminuria. Results were similar whether using eGFR(cys) or eGFR(cr). In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).

LIMITATIONS:

The cohort is composed of only female participants from urban communities within the United States.

CONCLUSIONS:

Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.

KEYWORDS:

Albumin; HIV (human immunodeficiency virus); albuminuria; chronic kidney disease (CKD) progression; disease trajectory; incident reduced estimated glomerular filtration rate (eGFR); kidney function

PMID:
25059222
PMCID:
PMC4177337
DOI:
10.1053/j.ajkd.2014.05.015
[Indexed for MEDLINE]
Free PMC Article
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