Serum albumin and kidney function decline in HIV-infected women

Joshua Lang; Rebecca Scherzer; Phyllis C. Tien; Chirag R. Parikh; Kathryn Anastos; Michelle M. Estrella; Alison G. Abraham; Anjali Sharma; Mardge H. Cohen; Anthony W. Butch; Marek Nowicki; Carl Grunfeld; Michael G. Shlipak

doi:10.1053/j.ajkd.2014.05.015

Serum albumin and kidney function decline in HIV-infected women

Joshua Lang, Rebecca Scherzer, Phyllis C. Tien, Chirag R. Parikh, Kathryn Anastos, Michelle M. Estrella, Alison G. Abraham, Anjali Sharma, Mardge H. Cohen, Anthony W. Butch, Marek Nowicki, Carl Grunfeld, Michael G. Shlipak

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.

Study Design Retrospective cohort analysis.

Setting & Participants Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.

Predictor The primary predictor was serum albumin concentration.

Outcomes We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).

Results After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFR_cys (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m² after adjustment for albuminuria. Results were similar whether using eGFR_cys or eGFR_cr. In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).

Limitations The cohort is composed of only female participants from urban communities within the United States.

Conclusions Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.

Measurements Kidney function decline was determined by cystatin C-based (eGFR_cys) and creatinine-based eGFR (eGFR_cr) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.

Original language	English (US)
Pages (from-to)	584-591
Number of pages	8
Journal	American Journal of Kidney Diseases
Volume	64
Issue number	4
DOIs	https://doi.org/10.1053/j.ajkd.2014.05.015
State	Published - Oct 1 2014

Keywords

Albumin
HIV (human immunodeficiency virus)
albuminuria
chronic kidney disease (CKD) progression
disease trajectory
incident reduced estimated glomerular filtration rate (eGFR)
kidney function

ASJC Scopus subject areas

Nephrology

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10.1053/j.ajkd.2014.05.015

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title = "Serum albumin and kidney function decline in HIV-infected women",

abstract = "Background Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.Study Design Retrospective cohort analysis.Setting & Participants Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.Predictor The primary predictor was serum albumin concentration.Outcomes We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).Results After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFRcys (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m2 after adjustment for albuminuria. Results were similar whether using eGFRcys or eGFRcr. In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).Limitations The cohort is composed of only female participants from urban communities within the United States.Conclusions Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.Measurements Kidney function decline was determined by cystatin C-based (eGFRcys) and creatinine-based eGFR (eGFRcr) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.",

keywords = "Albumin, HIV (human immunodeficiency virus), albuminuria, chronic kidney disease (CKD) progression, disease trajectory, incident reduced estimated glomerular filtration rate (eGFR), kidney function",

author = "Joshua Lang and Rebecca Scherzer and Tien, {Phyllis C.} and Parikh, {Chirag R.} and Kathryn Anastos and Estrella, {Michelle M.} and Abraham, {Alison G.} and Anjali Sharma and Cohen, {Mardge H.} and Butch, {Anthony W.} and Marek Nowicki and Carl Grunfeld and Shlipak, {Michael G.}",

note = "Publisher Copyright: {\textcopyright} 2014 American Diabetes Association and the National Kidney Foundation.",

year = "2014",

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day = "1",

doi = "10.1053/j.ajkd.2014.05.015",

language = "English (US)",

volume = "64",

pages = "584--591",

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T1 - Serum albumin and kidney function decline in HIV-infected women

AU - Lang, Joshua

AU - Scherzer, Rebecca

AU - Tien, Phyllis C.

AU - Parikh, Chirag R.

AU - Anastos, Kathryn

AU - Estrella, Michelle M.

AU - Abraham, Alison G.

AU - Sharma, Anjali

AU - Cohen, Mardge H.

AU - Butch, Anthony W.

AU - Nowicki, Marek

AU - Grunfeld, Carl

AU - Shlipak, Michael G.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.Study Design Retrospective cohort analysis.Setting & Participants Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.Predictor The primary predictor was serum albumin concentration.Outcomes We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).Results After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFRcys (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m2 after adjustment for albuminuria. Results were similar whether using eGFRcys or eGFRcr. In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).Limitations The cohort is composed of only female participants from urban communities within the United States.Conclusions Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.Measurements Kidney function decline was determined by cystatin C-based (eGFRcys) and creatinine-based eGFR (eGFRcr) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.

AB - Background Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women.Study Design Retrospective cohort analysis.Setting & Participants Study participants were recruited from the Women's Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and 2 follow-up measurements over an average of 8 years.Predictor The primary predictor was serum albumin concentration.Outcomes We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR).Results After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFRcys (P < 0.001), which was attenuated only slightly to 0.55 mL/min/1.73 m2 after adjustment for albuminuria. Results were similar whether using eGFRcys or eGFRcr. In adjusted analyses, each 0.5-g/dL lower baseline serum albumin level was associated with a 1.71-fold greater risk of rapid kidney function decline (P < 0.001) and a 1.72-fold greater risk of incident reduced eGFR (P < 0.001).Limitations The cohort is composed of only female participants from urban communities within the United States.Conclusions Lower serum albumin levels were associated strongly with kidney function decline and incident reduced eGFRs in HIV-infected women independent of HIV disease status, body mass index, and albuminuria.Measurements Kidney function decline was determined by cystatin C-based (eGFRcys) and creatinine-based eGFR (eGFRcr) at baseline and follow-up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression.

KW - Albumin

KW - HIV (human immunodeficiency virus)

KW - albuminuria

KW - chronic kidney disease (CKD) progression

KW - disease trajectory

KW - incident reduced estimated glomerular filtration rate (eGFR)

KW - kidney function

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Serum albumin and kidney function decline in HIV-infected women

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