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Hypertension. 2017 Feb;69(2):304-313. doi: 10.1161/HYPERTENSIONAHA.116.08258. Epub 2016 Dec 19.

Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women.

Author information

1
From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.).
2
From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.). michael.shlipak@ucsf.edu.

Abstract

Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected people. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C, urine albumin-to-creatinine ratio, and 7 urine biomarkers of tubular injury: α-1-microglobulin, interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver fatty acid-binding protein, N-acetyl-β-d-glucosaminidase, and α1-acid-glycoprotein. We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as 2 consecutive visits of antihypertensive medication use. During a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher urine albumin-to-creatinine ratio was independently associated with incident hypertension (relative risk =1.13 per urine albumin-to-creatinine ratio doubling, 95% confidence interval, 1.07-1.20), as was lower estimated glomerular filtration rate (relative risk =1.10 per 10 mL/min/1.73 m2 lower estimated glomerular filtration rate; 95% confidence interval, 1.04-1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, urine albumin-to-creatinine ratio was not associated with incident hypertension, whereas higher urine interleukin-18, α1-acid-glycoprotein, and N-acetyl-β-d-glucosaminidase levels were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in HIV-infected people. The associations of tubular markers with hypertension in HIV-uninfected women should be validated in other studies.

KEYWORDS:

HIV; albuminuria; glomerular filtration rate; hypertension; kidney disease

PMID:
27993956
PMCID:
PMC5233560
DOI:
10.1161/HYPERTENSIONAHA.116.08258
[Indexed for MEDLINE]
Free PMC Article

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