Dickkopf 3 - A novel biomarker for chronic kidney disease and its progression in people living with HIV?

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Background Thanks to the great advance in antiretroviral therapy (ART), people living with HIV (PLWH) nowadays have a normal life expectancy. Due to chronic (subclinical) inflammation and long-term intake of potentially nephrotoxic medication, PLWH are at an elevated risk for CKD. Urinary Dickkopf 3 (uDKK3) acts as a noninvasive marker of renal tubular damage and predictor of progressive CKD. It has not been investigated in PLWH. Methods This observational study included 427 PLWH from the HIV outpatient clinic of the Department of Dermatology at the University Hospital Essen. We examined uDKK3-to-creatinine levels in PLWH with and without CKD. Renal function evolution was retrospectively assessed in order to investigate the relation between uDKK3 and CKD progression. Results Urinary DKK3-to-creatinine concentrations were significantly higher in PLWH with CKD and were associated with lower eGFR according to cystatin C ( p = 0·009) and creatinine ( p = 0·003). There was a trend towards higher uDKK3-to-creatinine concentrations in progressive CKD compared to non-progressive CKD, without reaching significance (OR 1·27; 95%-CI 0·33-2·08; p = 0·33). Conclusions Urinary DKK3, a noninvasive marker, not only detects CKD in PLWH, but could also indicate its progression. This could help to identify PLWH with progressive CKD in need of effective treatment.

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