Medium‐grade proteinuria is a risk factor for incident markers of chronic kidney disease

Schrader, S. Y.; Zeder, A. J.; Hilge, R.; Bogner, J. R. und Seybold, Ulrich (2020): Medium‐grade proteinuria is a risk factor for incident markers of chronic kidney disease. In: HIV Medicine, Bd. 21, Nr. 8: S. 481-491

Abstract

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1468-1293
• Sprache: Englisch