Medium Grade Proteinuria Is Not a Relevant Predictor of Chronic Kidney Disease in People Living with HIV/AIDS

Le résumé fourni par la source

Proteinuria is a frequent finding among people living with HIV/AIDS (PLHA). Mostly it is medium grade (100–500 mg/g creatinine) without relevant albuminuria. In order to assess the prognostic relevance of medium grade proteinuria in PLHA we performed a prospective cohort study. Among PLHA from a university-hospital associated outpatient clinic in Munich, Germany, quantitative urinalysis was performed from 2009 to 2011 (baseline) and again 2014 to 2016 (follow-up) in addition to routine laboratory analysis during regular clinic visits. Informed consent was obtained. Demographic and medical data were abstracted from patient charts. Preexisting renal disease and overt proteinuria >500 mg/g creatinine were exclusion criteria. Primary endpoint was renal function (measured as eGFR, CKD-EPI creatinine equation) after 5 years of follow-up comparing PLHA with baseline total proteinuria of <100 mg to those with 100–500 mg/g creatinine. Informed consent and follow-up data were available for 277 PLHA. At baseline 122 (44%) had no relevant proteinuria (group 1) while 155 (56%) had medium-grade proteinuria of 100–500 mg/g creatinine (group 2). After a median follow-up of 1680 d median eGFR decreased from 104 to 89 ml/minute in group 1 and from 104 to 86 ml/minute in group 2. This difference was statistically significant (P < 0.001). There was no clinically relevant difference with respect to median total proteinuria at follow-up (90 vs. 85 mg/g creatinine). Between the groups there was no significantly different change from baseline to follow-up with respect to either potentially nephrotoxic drugs (tenofovir DF, protease inhibitors) or drugs potentially inhibiting creatinine secretion (dolutegravir, cobicistat), nor with respect to nephroprotective agents (ACE-inhibitors, AT2-receptor antagonists). Among PLHA in Germany without preexisting renal disease medium grade proteinuria of 100–500 mg/g creatinine was associated with statistically significant but very small increase of eGFR decline after 5 years of follow-up. Unexpectedly proteinuria at baseline was not predictive of proteinuria at follow-up. Differential drug treatment does not explain these observations. All authors: No reported disclosures.

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