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NDT Advance Access published online on May 9, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn236
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© The Author [2008]. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population

Morten Baekken1,2, Ingrid Os2,3, Leiv Sandvik4 and Olav Oektedalen1

1 Department of Infectious Diseases, Ullevaal University Hospital 2 Faculty of Medicine, University of Oslo 3 Department of Nephrology 4 Center of Clinical Research, Ullevaal University Hospital, Oslo, Norway

Correspondence and offprint requests to: Morten Baekken, Department of Infectious Diseases, Ullevaal University Hospital, 0407 Oslo, Norway. Tel: +472-211-9101; Fax: +472-211-9181; E-mail: morten.baekken{at}medisin.uio.no, olok{at}ulleval.no



  Abstract

Background. The survival of human immunodeficiency virus (HIV)-infected patients has increased significantly since the introduction of combination antiretroviral therapy, leading to the development of important long-term complications including cardiovascular disease (CVD) and renal disease. Microalbuminuria, an indicator of glomerular injury, is associated with an increased risk of progressive renal deterioration, CVD and mortality. However, the prevalence of microalbuminuria has barely been investigated in HIV-infected individuals.

Methods. Based on three prospective urine samples in an unselected nonhypertensive, nondiabetic HIV-positive cohort (n = 495), we analysed the prevalence of microalbuminuria and compared the Caucasian share with that of a nonhypertensive, nondiabetic population-based control group (n = 2091). Significant predictors for microalbuminuria were analysed within the HIV-positive cohort.

Results. The prevalence of microalbuminuria was 8.7% in the HIV-infected cohort, which is three to five times higher than that in the general population. HIV-infected patients with microalbuminuria were older, and had higher blood pressure, longer duration of HIV infection, higher serum beta 2-microglobulin, higher serum creatinine and a reduced glomerular filtration rate of ≤90 mL/min, compared with those with normal albumin excretion. In multivariate analysis, systolic blood pressure, serum beta 2-microglobulin and duration of HIV infection were found to be independent predictors of microalbuminuria.

Conclusions. Our findings indicate that in addition to haemodynamic effects, inflammatory activity may be implicated as a cause of the development of microalbuminuria. With respect to the increasing risk of developing CVD or renal diseases and mortality, the high prevalence of microalbuminuria in HIV-infected individuals warrants special attention.

Keywords: beta 2-microglobulin; blood pressure; combination antiretroviral treatment; HIV; microalbuminuria

Received for publication: 11. 1.08
Accepted in revised form: 28. 3.08


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