Ng Derek K, Jacobson Lisa P, Brown Todd T, Palella Frank J, Martinson Jeremy J, Bolan Robert, Miller Edgar R, Schwartz George J, Abraham Alison G, Estrella Michelle M
aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health bDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland cDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois dGraduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania eLos Angeles Gay and Lesbian Center, Los Angeles, California fWelch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland gDepartment of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
AIDS. 2014 Jan 28;28(3):377-86. doi: 10.1097/QAD.0000000000000094.
Diabetes and hypertension, common conditions in antiretroviral-treated HIV-infected individuals, are associated with glomerular hyperfiltration, which precedes the onset of proteinuria and accelerated kidney function decline. In the Multicenter AIDS Cohort Study, we examined the extent to which hyperfiltration is present and associated with metabolic, cardiovascular, HIV and treatment risk factors among HIV-infected men.
Cross-sectional cohort using direct measurement of glomerular filtration rate by iohexol plasma clearance for 367 HIV-infected men and 241 HIV-uninfected men who were free of chronic kidney disease.
Hyperfiltration was defined as glomerular filtration rate above 140-1 ml/min per 1.73 m per year over age 40. Multivariate logistic regression was used to estimate the odds ratios (ORs) of prevalent hyperfiltration for metabolic, cardiovascular, HIV and cumulative antiretroviral exposure factors.
Among individuals without chronic kidney disease, the prevalence of hyperfiltration was higher for HIV-infected participants (25%) compared to uninfected participants (17%; P = 0.01). After adjustment, HIV infection remained associated with hyperfiltration [OR 1.70, 95% confidence interval (CI) 1.11-2.61] and modified the association between diabetes and hyperfiltration, such that the association among HIV-uninfected men (OR 2.56, 95% CI 1.33-5.54) was not observed among HIV-infected men (OR 1.19, 95% CI 0.69-2.05). These associations were independent of known risk factors for hyperfiltration. Indicators of hyperglycemia and hypertension were also associated with hyperfiltration as was cumulative zidovudine exposure.
Hyperfiltration, a potential modifiable predictor of kidney disease progression, is significantly higher among antiretroviral-treated HIV-infected men. Furthermore, HIV-infection nullifies the association of diabetes and hyperfiltration present in HIV-uninfected men.
糖尿病和高血压是接受抗逆转录病毒治疗的HIV感染者的常见病症，与肾小球高滤过相关，而肾小球高滤过先于蛋白尿的出现和肾功能加速下降。在多中心艾滋病队列研究中，我们调查了HIV感染男性中高滤过的存在程度及其与代谢、心血管、HIV和治疗风险因素的相关性。
采用横断面队列研究，通过碘海醇血浆清除率直接测量367名HIV感染男性和241名未感染HIV且无慢性肾病的男性的肾小球滤过率。
高滤过定义为40岁以上每年每1.73平方米肾小球滤过率高于140-1毫升/分钟。采用多变量逻辑回归来估计代谢、心血管、HIV和累积抗逆转录病毒暴露因素导致的高滤过患病率的比值比（OR）。
在无慢性肾病的个体中，HIV感染参与者的高滤过患病率（25%）高于未感染参与者（17%；P = 0.01）。调整后，HIV感染仍与高滤过相关[OR 1.70，95%置信区间（CI）1.11-2.61]，并改变了糖尿病与高滤过之间的关联，使得在未感染HIV的男性中观察到的关联（OR 2.56，95% CI 1.33-5.54）在感染HIV的男性中未观察到（OR 1.19，95% CI 0.69-2.05）。这些关联独立于已知的高滤过风险因素。高血糖和高血压指标以及齐多夫定累积暴露也与高滤过相关。
高滤过是肾病进展的一个潜在可改变的预测指标，在接受抗逆转录病毒治疗的HIV感染男性中显著更高。此外，HIV感染消除了未感染HIV男性中糖尿病与高滤过之间的关联。
