Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls
Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls
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感染人类免疫缺陷病毒的中年人与未感染人类免疫缺陷病毒的人相比，慢性肾脏疾病的患病率更高，进展更快
DOI：
10.1093/infdis/jix202
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发表时间：
2017-09-15
影响因子：
6.4
通讯作者：
Reiss, Peter
中科院分区：
文献类型：
--
作者：
Kooij, Katherine W.;Vogt, Liffert;Reiss, Peter
背景。人类免疫缺陷病毒（HIV）感染者患慢性肾病（CKD）的风险增加。人类免疫缺陷病毒感染、传统 CKD 危险因素和联合抗逆转录病毒治疗 (cART) 都可能有所贡献。方法。我们比较了肾功能不全（估计肾小球滤过率 [eGFR] = 3 mg/mmol）和近端肾小管功能障碍（视黄醇结合蛋白/肌酐比值 >2.93 μg/mmol 和/或磷酸盐排泄分数 >20%，血浆磷酸盐 = 10%/年，蛋白尿类别发生变化）的患病率。结果。人类免疫缺陷病毒感染与肾功能损害（调整后比值比[aOR] = 2.1；95%置信区间[CI] = 1.0-4.4）、蛋白尿（aOR = 5.8；95% CI = 3.7-9.0）和近端肾小管功能障碍（aOR = 7.0；95% CI = 4.9-10.2]）独立相关。在纵向分析中纳入的 479 名 HIV 感染者和 377 名 HIV 未感染者（中位随访时间分别为 3.9/4.1 年）中，HIV 感染者和继续接受未经改良的 cART 与 eGFR 下降幅度更大（-0.56；95% CI = -0.87 至 -0.24 mL/min/1.73m(2)/年）和蛋白尿恶化独立相关（aOR = 2.3；95% CI = 1.3-4.0）。结论。在这些中年人中，HIV 感染与肾功能损害、蛋白尿和近端肾小管功能障碍独立相关。与未感染 HIV 的个体相比，接受 cART（主要含有富马酸替诺福韦二吡呋酯）的人类免疫缺陷病毒感染个体也更有可能出现 eGFR 下降和白蛋白尿恶化。
Background. Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute.Methods. We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] = 3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93 mu g/mmol and/or fractional phosphate excretion >20% with plasma phosphate = 10%/year with change in albuminuria category).Results. Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 479 HIV-infected and 377 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m(2)/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0).Conclusions. In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.