Ambulatory urine biomarkers associations with AKI and hospitalization in people with HIV: predictors of acute renal injury study (PARIS).

BACKGROUND: People living with HIV (PLWH) generally have worse ambulatory levels of kidney injury biomarkers and excess risk of acute kidney injury (AKI) compared to persons without HIV. We evaluated whether ambulatory measures of subclinical kidney injury among PLWH are associated with subsequent AKI.

METHODS: In the Predictors of Acute Renal Injury Study (PARIS), which enrolled 468 PLWH from April 2016 to August 2019, we measured 10 urine biomarkers of kidney health (albumin, a1m, b2 M, NGAL, IL18, KIM-1, EGF, UMOD, MCP-1, YKL40) at baseline and annually during follow-up. Using multivariable Cox regression models, we evaluated baseline and time-updated biomarker associations with the primary outcome of AKI (≥0.3 mg/dL or ≥1.5-times increase in serum creatinine from baseline) and secondary outcome of all-cause hospitalization.

RESULTS: At baseline, the mean age was 53 years old, and 45% self-identified as female. In time-updated models adjusting for sociodemographic factors, comorbidities, albuminuria, eGFR, and HIV-associated factors, higher KIM-1 (HR = 1.30 per 2-fold higher; 95% CI 1.03-1.63) and NGAL concentrations (HR = 1.24, 95% CI 1.06-1.44) were associated with higher risk of hospitalized AKI. Additionally, in multivariable, time-updated models, higher levels of KIM-1 (HR = 1.19, 95% CI 1.00, 1.41), NGAL (HR = 1.13, 95% CI 1.01-1.26), and MCP-1 (HR = 1.20, 95% CI 1.00, 1.45) were associated with higher risk of hospitalization.

CONCLUSIONS: Urine biomarkers of kidney tubular injury, such as KIM-1 and NGAL, are strongly associated with AKI among PLWH, and may hold potential for risk stratification of future AKI.