scholarly journals Associations of CKD risk factors and longitudinal changes in urine biomarkers of kidney tubules among women living with HIV

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anthony N. Muiru ◽  
Rebecca Scherzer ◽  
Simon B. Ascher ◽  
Vasantha Jotwani ◽  
Carl Grunfeld ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Hemoglobin A1c ◽  
Tubular Injury ◽  
Longitudinal Changes ◽  
Women Living With Hiv ◽  
Urine Biomarkers ◽  
Proximal Tubular ◽  
Living With Hiv

Abstract Background Novel urine biomarkers have enabled the characterization of kidney tubular dysfunction and injury among persons living with HIV, a population at an increased risk of kidney disease. Even though several urine biomarkers predict progressive kidney function decline, antiretroviral toxicity, and mortality in the setting of HIV infection, the relationships among the risk factors for chronic kidney disease (CKD) and urine biomarkers are unclear. Methods We assessed traditional and infection-related CKD risk factors and measured 14 urine biomarkers at baseline and at follow-up among women living with HIV in the Women’s Interagency Health Study (WIHS). We then used simultaneously adjusted multivariable linear regression models to evaluate the associations of CKD risk factors with longitudinal changes in biomarker levels. Results Of the 647 women living with HIV in this analysis, the majority (67%) were Black, the median age was 45 years and median follow-up time was 2.5 years. Each traditional and infection-related CKD risk factor was associated with a unique set of changes in urine biomarkers. For example, baseline hemoglobin a1c was associated with worse tubular injury (higher interleukin [IL]-18), proximal tubular reabsorptive dysfunction (higher α1-microglobulin), tubular reserve (lower uromodulin) and immune response to injury (higher chitinase-3-like protein-1 [YKL-40]). Furthermore, increasing hemoglobin a1c at follow-up was associated with further worsening of tubular injury (higher kidney injury molecule-1 [KIM-1] and IL-18), as well as higher YKL-40. HCV co-infection was associated with worsening proximal tubular reabsorptive dysfunction (higher β2-microglobulin [β2m]), and higher YKL-40, whereas HIV viremia was associated with worsening markers of tubular and glomerular injury (higher KIM-1 and albuminuria, respectively). Conclusions CKD risk factors are associated with unique patterns of biomarker changes among women living with HIV, suggesting that serial measurements of multiple biomarkers may help in detecting and monitoring kidney disease in this setting.

scholarly journals Incident Non-AIDS Comorbidity Burden among Women with or at-risk for HIV in the U.S

2021 ◽  
Author(s):  
Lauren F Collins ◽  
Anandi N Sheth ◽  
C Christina Mehta ◽  
Susanna Naggie ◽  
Elizabeth T Golub ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Age Groups ◽  
Women Living With Hiv ◽  
Accelerate Development ◽  
Clinical Covariates ◽  
Comorbidity Burden ◽  
Hiv Serostatus ◽  
Living With Hiv

Abstract Background HIV infection may accelerate development of aging-related non-AIDS comorbidities (NACM). The incidence of NACM is poorly characterized among women living with HIV (WLWH). Methods WLWH and HIV-seronegative participants followed in the Women’s Interagency HIV Study (WIHS) through ≥2009 (when >80% of WLWH used antiretroviral therapy) were included, with outcomes measured through 3/31/2018. Sociodemographics, clinical covariates and prevalent NACM were determined at enrollment. We used Poisson regression models to determine incident NACM burden (number of NACM accrued through most recent WIHS visit out of ten total NACM assessed) by HIV serostatus and age. Results There were 3,129 participants (2239 WLWH, 890 HIV-seronegative) with 36,589 person-years of follow-up. At enrollment, median age was 37 years, 65% were black, 47% currently smoked. In fully-adjusted analyses, WLWH had a higher incident NACM rate compared with HIV-seronegative women (IRR 1.36, 95% CI 1.02-1.81). Incident NACM burden was higher among WLWH versus HIV-seronegative women in most age strata (HIV*age interaction p=0.0438) and women <25 years old had the greatest incidence rate ratio by HIV serostatus at 1.48 (95% CI 1.19-1.84) compared with those in older age groups. Incident NACM burden was associated with traditional comorbidity risk factors, but not HIV-specific indices. Conclusions Incident NACM burden was higher among WLWH than HIV-seronegative women. This difference was most dramatic among women aged <25 years, a group for whom routine comorbidity screening is not prioritized. Established non-HIV comorbidity risk factors were significantly associated with incident NACM burden. More data are needed to inform best practices for NACM screening, prevention and management among WLWH, particularly young women.

scholarly journals Urine Biomarkers of Kidney Tubule Health and Incident CKD Stage 3 in Women Living With HIV: A Repeated Measures Study

2021 ◽  
Author(s):  
Simon B. Ascher ◽  
Rebecca Scherzer ◽  
Michelle M. Estrella ◽  
Vasantha K. Jotwani ◽  
Judy Shigenaga ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Kidney Tubule ◽  
Women Living With Hiv ◽  
Urine Biomarkers ◽  
Ckd Stage ◽  
Living With Hiv

scholarly journals Patterns of changing pregnancy intentions among women living with HIV in Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lashanda Skerritt ◽  
Angela Kaida ◽  
Nadia O’Brien ◽  
Ann N. Burchell ◽  
Gillian Bartlett ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Healthcare Providers ◽  
Undetectable Viral Load ◽  
Subsequent Pregnancy ◽  
Reproductive Age ◽  
Pregnancy Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Health Cohort Study

Abstract Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

scholarly journals Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Agnes Napyo Kasede ◽  
Thorkild Tylleskär ◽  
David Mukunya ◽  
Josephine Tumuhamye ◽  
Grace Ndeezi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Home Delivery ◽  
Northern Uganda ◽  
Adjusted Risk ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
At Home

Abstract Background Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker). Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home. Conclusion Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.

scholarly journals Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

2019 ◽  
Vol 41 (4) ◽  
pp. 462-471 ◽  
Author(s):  
Kellen Hyde Elias Pinheiro ◽  
Franciana Aguiar Azêdo ◽  
Kelsy Catherina Nema Areco ◽  
Sandra Maria Rodrigues Laranja
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Icu Patients ◽  
Septic Acute Kidney Injury ◽  
Observational Cohort ◽  
Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

scholarly journals Incidence of Chronic Kidney Disease and Its Risk Factors, Results of Over 10 Year Follow Up in an Iranian Cohort

PLoS ONE ◽  
2012 ◽  
Vol 7 (9) ◽  
pp. e45304 ◽  
Author(s):  
Maryam Tohidi ◽  
Mitra Hasheminia ◽  
Reza Mohebi ◽  
Davood Khalili ◽  
Farhad Hosseinpanah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease

scholarly journals Associations of Urine Biomarkers with Kidney Function Decline in HIV-Infected and Uninfected Men

2019 ◽  
Vol 50 (5) ◽  
pp. 401-410 ◽  
Author(s):  
Simon B. Ascher ◽  
Rebecca Scherzer ◽  
Michelle M. Estrella ◽  
Michael G. Shlipak ◽  
Derek K. Ng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Kidney Function ◽  
Disease Risk ◽  
Kidney Injury ◽  
Procollagen Type ◽  
Urine Albumin ◽  
Urine Biomarkers ◽  
Increased Risk ◽  
Egfr Decline

Background: HIV-infected (HIV+) persons are at increased risk of chronic kidney disease, but serum creatinine does not detect early losses in kidney function. We hypothesized that urine biomarkers of kidney damage would be associated with subsequent changes in kidney function in a contemporary cohort of HIV+ and HIV-uninfected (HIV–) men. Methods: In the Multicenter AIDS Cohort Study, we measured baseline urine concentrations of 5 biomarkers from 2009 to 2011 in 860 HIV+ and 337 HIV– men: albumin, alpha-1-microglobulin (α1m), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and procollagen type III N-terminal propeptide (PIIINP). We evaluated associations of urine biomarker concentrations with annual changes in estimated glomerular filtration rate (eGFR) using multivariable linear mixed models adjusted for demographics, traditional kidney disease risk factors, HIV-related risk factors, and baseline eGFR. Results: Over a median follow-up of 4.8 years, the average annual eGFR decline was 1.42 mL/min/1.73 m2/year in HIV+ men and 1.22 mL/min/1.73 m2/year in HIV– men. Among HIV+ men, the highest vs. lowest tertiles of albumin (–1.78 mL/min/1.73 m2/year, 95% CI –3.47 to –0.09) and α1m (–2.43 mL/min/1.73 m2/year, 95% CI –4.14 to –0.73) were each associated with faster annual eGFR declines after multivariable adjustment. Among HIV– men, the highest vs. lowest tertile of α1m (–2.49 mL/min/1.73 m2/year, 95% CI –4.48 to –0.50) was independently associated with faster annual eGFR decline. Urine IL-18, KIM-1, and PIIINP showed no independent associations with eGFR decline, regardless of HIV serostatus. Conclusions: Among HIV+ men, higher urine albumin and α1m are associated with subsequent declines in kidney function, independent of eGFR.

scholarly journals Maternal and Fetal Outcomes of Pregnancy in Nephrotic Syndrome Due to Primary Glomerulonephritis

2020 ◽  
Vol 7 ◽  
Author(s):  
Rossella Siligato ◽  
Guido Gembillo ◽  
Valeria Cernaro ◽  
Francesco Torre ◽  
Antonino Salvo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Kidney Disease ◽  
Survival Data ◽  
Neonatal Intensive Care ◽  
Fetal Outcomes ◽  
Primary Glomerulonephritis ◽  
Ckd Stage ◽  
Kidney Disease Progression

Chronic kidney disease (CKD) affects 3% of pregnancies, impacting on maternal and fetal outcomes, and at the same time, a recurrent question in nephrology regards gestation impact on kidney function. Observational studies stated that CKD stage, pre-existent hypertension, and proteinuria are the main predictors of possible complications, such as maternal CKD progression, maternal or fetal death, prematurity, small for gestational age (SGA) newborn, or admission to the neonatal intensive care unit. In this regard, given the prominence of proteinuria among other risk factors, we focused on primary nephrotic syndrome in pregnancy, which accounts for 0.028% of cases, and its impact on materno-fetal outcomes and kidney survival. Data extracted from literature are scattered because of the small cohorts investigated in each trial. However, they showed different outcomes for each glomerular disease, with membranous nephropathy (MN) having a better maternal and fetal prognosis than focal and segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), or minimal change disease (MCD). Nephrotic syndrome does not have to discourage women to undertake a pregnancy, but the correct management may include a specific evaluation of risk factors and follow-up for adverse materno-fetal events and/or maternal kidney disease progression.

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