Background: Kidney disease has become an important cause of morbidity and mortality in HIV-infected patients in Western countries. Japan is a country with an increasing number of newly infected HIV patients. However, only a few studies have investigated kidney disease in Asian populations infected with HIV. Methods: We studied the prevalence of kidney disease by reviewing the clinical data of 732 HIV-infected Japanese patients. Risk factors for proteinuria, albuminuria, and renal dysfunction were determined using multivariate logistic regression analysis. Results: Microalbuminuria, macroalbuminuria and proteinuria were present in 13.2, 4.55 and 9.52% of patients, respectively. The prevalence of chronic kidney disease of any stage and CKD ≧ stage 3 was 15.4 and 9.70%, respectively. Multivariate analysis showed significant associations between increasing levels of serum creatinine and cholesterol, and the coexistence of diabetes, hypertension and hepatitis C coinfection with either proteinuria or albuminuria, which was significantly related to the presence of renal dysfunction. Lower CD4 cell count was associated with the presence of renal dysfunction, but higher HIV-RNA level was not. Conclusions: Our study has shown the international dimension of the burden of kidney disease in HIV-infected patients. Either proteinuria or albuminuria is likely the most significant factor for renal dysfunction in these patients.

1.
Lohse N, Hansen AB, Pedersen G, et al: Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007;146:87–95.
2.
Mocroft A, Ledergerber B, Katlama C, et al: Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 2003;362:22–29.
3.
Gupta SK, Eustace JA, Winston JA, et al: Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005;40:1559–1585.
4.
Eggers PW, Kimmel PL: Is there an epidemic of HIV Infection in the US ESRD program? J Am Soc Nephrol 2004;15:2477–2485.
5.
Schwartz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE: Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 2005;16:2412–2420.
6.
Winston J, Deray G, Hawkins T, Szczech L, Wyatt C, Young B: Kidney disease in patients with HIV infection and AIDS. Clin Infect Dis 2008;47:1449–1457.
7.
Odden MC, Scherzer R, Bacchetti P, et al: Cystatin C level as a marker of kidney function in human immunodeficiency virus infection: the FRAM study. Arch Intern Med 2007;167:2213–2219.
8.
Cheung CY, Wong KM, Lee MP, et al: Prevalence of chronic kidney disease in Chinese HIV-infected patients. Nephrol Dial Transplant 2007;22:3186–3190.
9.
Mocroft A, Kirk O, Gatell J, et al: Chronic renal failure among HIV-1-infected patients. AIDS 2007;21:1119–1127.
10.
Wyatt CM, Winston JA, Malvestutto CD, et al: Chronic kidney disease in HIV infection: an urban epidemic. AIDS 2007;21:2101–2103.
11.
Fernando SK, Finkelstein FO, Moore BA, Weissman S: Prevalence of chronic kidney disease in an urban HIV-infected population. Am J Med Sci 2008;335:89–94.
12.
Post FA, Holt SG: Recent developments in HIV and the kidney. Curr Opin Infect Dis 2009;22:43–48.
13.
Nunez M, Saran AM, Freedman BI: Gene-gene and gene-environment interactions in HIV-associated nephropathy: a focus on the MYH9 nephropathy susceptibility gene. Adv Chronic Kidney Dis 2010;17:44–51.
14.
Lucas GM, Eustace JA, Sozio S, Mentari EK, Appiah KA, Moore RD: Highly active antiretroviral therapy and the incidence of HIV-1-associated nephropathy: a 12-year cohort study. AIDS 2004;18:541–546.
15.
Matsuo S, Imai E, Horio M, et al: Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982–992.
16.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–S266.
17.
Ando M, Iwamoto Y, Suda A, Tsuchiya K, Nihei H: New insights into the thrombopoietic status of patients on dialysis through the evaluation of megakaryocytopoiesis in bone marrow and of endogenous thrombopoietin levels. Blood 2001;97:915–921.
18.
Nakamura Y, Shibuya A, Suzuki H, Ando M: Prevalence of chronic kidney disease and significant contributors to chronic kidney disease in HIV-infected patients. Nippon Jinzo Gakkai Shi 2008;50:499–505.
19.
Gardner LI, Holmberg SD, Williamson JM, et al: Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J Acquir Immune Defic Syndr 2003;32:203–209.
20.
Gupta SK, Mamlin BW, Johnson CS, Dollins MD, Topf JM, Dube MP: Prevalence of proteinuria and the development of chronic kidney disease in HIV-infected patients. Clin Nephrol 2004;61:1–6.
21.
Szczech LA, Hoover DR, Feldman JG, et al: Association between renal disease and outcomes among HIV-infected women receiving or not receiving antiretroviral therapy. Clin Infect Dis 2004;39:1199–1206.
22.
Szczech LA, Gange SJ, van der Horst C, et al: Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int 2002;61:195–202.
23.
Morten B, Os I, Sandvik L, Oektedalen O: Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population. Nephrol Dial Transplant 2008;23:3130–3137.
24.
Szczech LA, Grunfeld C, Scherzer R, et al: Microalbuminuria in HIV infection. AIDS 2007;21:1003–1009.
25.
Imai E, Horio M, Watanabe T, et al: Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol 2009;13:621–630.
26.
Choi AI, Li Y, Deeks SG, Grunfeld C, Volberding PA, Shlipak MG: Association between kidney function and albuminuria with cardiovascular events in HIV-Infected persons. Circulation 2010;121:651–658.
27.
Jones CY, Jones CA, Wilson IB, et al: Cystatin C and creatinine in an HIV cohort: the nutrition for healthy living study. Am J Kidney Dis 2008;51:914–924.
28.
Fulop T, Oliver J, Meador RS, et al: Screening for chronic kidney disease in the ambulatory HIV population. Clin Nephrol 2010;73:190–196.
29.
Dharnidharka VR, Kwon C, Stevens G: Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002;40:221–226.
30.
Knight EL, Verhave JC, Spiegelman D, et al: Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004;65:1416–1421.
31.
Mauss S, Berger F, Kuschak D, et al: Cystatin C as a marker of renal function is affected by HIV replication leading to an underestimation of kidney function in HIV patients. Antivir Ther 2008;13:1091–1095.
32.
Barraclough K, Er L, Ng F, Harris M, Montaner J, Levin A: A comparison of the predictive performance of different methods of kidney function estimation in a well-characterized HIV-infected population. Nephron Clin Pract 2009;111:c39–c48.
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