Risk Factors for Proteinuria in HIV-Infected and -Uninfected Hispanic Drug Users
Received 13 September 2007; accepted 14 April 2008. published online 24 June 2008.
Background
Proteinuria may be an early marker of chronic kidney disease in human immunodeficiency virus (HIV)-infected patients with coexisting chronic hepatitis and/or drug use. Minorities are at greater risk of chronic kidney disease. Data are limited about risk factors for proteinuria in Hispanic drug users with and without HIV infection.
Study Design
A cross-sectional study.
Setting & Participants
A community-recruited Hispanic cohort to study the role of drug use in HIV-associated malnutrition composed of 4 groups (106 HIV-infected drug users, 96 HIV-uninfected drug users, 38 HIV-infected non–drug users, and 47 healthy controls). Patients on renal replacement therapy were excluded.
Predictors
HIV infection, chronic hepatitis, history of hypertension or diabetes, and intravenous drug use (never, prior, or current).
Outcomes & Measurements
The presence of proteinuria was defined as urine dipstick result of 1+ or greater. Multivariable logistic regression was used to identify independent risk factors for proteinuria.
Results
Of 287 patients with available data, 24 (8.4%) had proteinuria. In univariate analyses, those with HIV infection; prior, but not current, intravenous drug use; and a history of hypertension or diabetes were more likely to have proteinuria. In multivariate analyses, significant risk factors for proteinuria were HIV infection (odds ratio, 9.2; 95% confidence interval, 1.9 to 45.8; P = 0.007); prior, but not current, intravenous drug use (odds ratio, 4.7; 95% confidence interval, 1.4 to 15.3; P = 0.01); and history of hypertension or diabetes (odds ratio, 8.2; 95% confidence interval, 3.1 to 21.7; P < 0.001).
Limitations
The cross-sectional study design makes it difficult to establish the temporal relationship. The number of outcomes in relation to the number of predictors is small.
Conclusions
HIV and prior intravenous drug use, but not chronic hepatitis or current intravenous drug use, were independently associated with proteinuria in this Hispanic population. Longitudinal studies to assess the development of proteinuria and chronic kidney disease in this high-risk population are warranted.
1Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
2Biostatistics Research Center, Tufts Medical Center, Boston, MA
3Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA
4Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
Address correspondence to Martin S. Rhee, MD, Tufts Medical Center, 800 Washington St, Box 41, Boston, MA 02111
Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Robert Nelson, MD, National Institutes of Health) who served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.
ABSTRACT