HIV infection remains an established risk factor for chronic kidney disease (CKD). Increased urinary protein and albumin excretion assessment are important markers of CKD prevalence and progression. Here, we present data regarding prevalence of proteinuria and albuminuria among REPRIEVE participants with baseline urine testing.
REPRIEVE is an international primary cardiovascular prevention RCT of pitavastatin calcium vs. placebo among 7,770 PWH ages 40-75 on antiretroviral therapy with eGFR ?60 mL/min/1.73mm2. A representative subset of 2512 participants had urine collected at study entry. Previously defined categories of urine protein to creatinine ratios (uPCR) and albumin to creatinine ratios (uACR) were used. uPCR: Normal (<150mg/g), Moderately Increased (150-500mg/g), and Severely Increased (>500mg/g); uACR: Normal (<30mg/g), Moderately Increased (30-300mg/g), and Severely Increased (>300mg/g). These were dichotomized to Normal or Abnormal for log-binomial regression analysis. Risk of abnormal proteinuria and albuminuria was assessed by demographic, cardiometabolic, and HIV-specific data.
Sample demographics (n=2512) included median age 49 years, 41% female sex, 47% black or African American race, median BMI 26 kg/m2, median CD4 count 619 c/mm3, and 98% with HIV VL <400cp/ml. Median eGFR was 98 mL/min/1.73mm2; 36% had eGFR <90 mL/min/1.73mm2. For uPCR (n=2475), 72% had normal, 25% moderately increased, and 3% severely increased values. For uACR (n=2512), 90% had normal, 9% moderately increased, and 1% severely increased values. In the adjusted model for abnormal proteinuria, female sex, older age, residence in sub-Saharan Africa, current or former smoking status, diagnosis of HTN, lower BMI and, use of TDF were associated with abnormal values. In the adjusted model for abnormal albuminuria, diagnosis of HTN, and certain NRTI exposures were associated with abnormal values. Neither nadir nor current CD4 count was associated with abnormal proteinuria or albuminuria.
In this cohort with controlled HIV, high CD4 cell counts, and preserved eGFR, abnormal proteinuria and albuminuria remain common (28% and 10%). While HIV parameters were not associated with abnormal values, TDF use was strongly associated with abnormal proteinuria. Additionally, certain modifiable comorbidities, including HTN and smoking, were associated with abnormal values. In PWH with preserved eGFR, subclinical kidney disease can be identified using urine measures.