Muramatsu Takashi, Yanagisawa Naoki, Chikasawa Yushi, Seita Ikuo, Yotsumoto Mihoko, Otaki Manabu, Ogata Kyoichi, Hagiwara Takeshi, Suzuki Takashi, Suganuma Akihiko, Imamura Akifumi, Amano Kagehiro, Yamamoto Yasuyuki, Nitta Kosaku, Ajisawa Atsushi, Fukutake Katsuyuki, Ando Minoru
Department of Laboratory Medicine, Tokyo Medical University.
Kansenshogaku Zasshi. 2013 Jan;87(1):14-21. doi: 10.11150/kansenshogakuzasshi.87.14.
The improved survival of subjects with human immunodeficiency virus (HIV) has been accompanied by an increased prevalence of chronic kidney disease (CKD). Epidemic of CKD among those with HIV has not yet been evaluated in multiple tertiary hospitals in Japan.
A cross-sectional study was conducted in 2011 at Tokyo Metropolitan Komagome Hospital (TMKH) and Tokyo Medical University Hospital (TMUH). A total of 1482 HIV-infected subjects (1384 men, 98 female, mean age: 44.2 +/- 11.4 years old) were consecutively enrolled in the study. Random urine and blood samples were collected to study prevalence of CKD. CKD was diagnosed as a decrease in glomerular function and/or proteinuria and classified into 5 stages based on National Kidney Foundation guidelines. The estimated glomerular filtration rate based on serum creatinine was calculated using the 3-variable equation, constructed by the Japanese Society of Nephrology. Proteinuria was defined as > or = 1+ on urine dipstick examination. All electronic medical charts were reviewed to determine comorbidities, including hypertension and diabetes mellitus (DM). The proportion of subjects receiving tenofovir disoproxil fumarate (TDF) was investigated. Risk factors for CKD were determined using multivariate logistic regression analysis.
The mean CD4 cell count was 487 +/- 216/microL and 80.5% had undetectable HIV-RNA level in the combined cohort. Of the 90.2% of subjects taking antiretroviral agents, 61.5% was using TDF. The prevalence of overall CKD and CKD > or = stage 3 was 12.9% and 6.7%, respectively, both of which were nearly 3-fold higher in the TMKH cohort (p < .0001). Mean age and proportional prevalent hypertension and DM were significantly higher in the TKMH cohort than in the TMUH cohort. Multivariate analysis showed significant CKD to be associated with age > or =50 years (odds ratio [OR], 2.81), hypertension (OR, 3.04), and DM (OR, 2.05).
CKD prevalence was 12.9% among combined cohorts, but differed significantly between them. Differences in age distribution and the proportion of comorbidities, including hypertension and DM, are likely involved.
随着人类免疫缺陷病毒（HIV）感染者生存率的提高，慢性肾脏病（CKD）的患病率也有所上升。日本多家三级医院尚未对HIV感染者中的CKD流行情况进行评估。
2011年在东京都驹込医院（TMKH）和东京医科大学医院（TMUH）进行了一项横断面研究。共有1482名HIV感染者（1384名男性，98名女性，平均年龄：44.2±11.4岁）连续纳入研究。收集随机尿液和血液样本以研究CKD的患病率。CKD被诊断为肾小球功能下降和/或蛋白尿，并根据美国国立肾脏基金会指南分为5期。基于血清肌酐的估计肾小球滤过率使用日本肾脏病学会构建的三变量方程进行计算。蛋白尿定义为尿试纸检查≥1+。审查所有电子病历以确定合并症，包括高血压和糖尿病（DM）。调查接受富马酸替诺福韦二吡呋酯（TDF）治疗的受试者比例。使用多因素逻辑回归分析确定CKD的危险因素。
联合队列中的平均CD4细胞计数为487±216/μL，80.5%的患者HIV-RNA水平检测不到。在服用抗逆转录病毒药物的90.2%的受试者中，61.5%使用TDF。总体CKD和CKD≥3期的患病率分别为12.9%和6.7%，在TMKH队列中两者均高出近3倍（p<0.0001）。TMKH队列中的平均年龄以及高血压和DM的患病率比例均显著高于TMUH队列。多因素分析显示，CKD与年龄≥50岁（比值比[OR]，2.81）、高血压（OR，3.04）和DM（OR，2.05）相关。
联合队列中CKD患病率为12.9%，但两个队列之间存在显著差异。年龄分布以及高血压和DM等合并症比例的差异可能是原因所在。
