Association of Kidney Function and Early Kidney Injury with Incident Hypertension in HIV-Infected Women

Simon B. Ascher, Rebecca Scherzer, Carmen A. Peralta, Phyllis C. Tien, Carl Grunfeld, Michelle M. Estrella, Alison Abraham, Deborah R. Gustafson, Marek Nowicki, Anjali Sharma, Mardge H. Cohen, Anthony W. Butch, Mary A. Young, Michael R. Bennett, Michael G. Shlipak

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected people. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C, urine albumin-To-creatinine ratio, and 7 urine biomarkers of tubular injury: α-1-microglobulin, interleukin-18, kidney injury molecule-1, neutrophil gelatinase-Associated lipocalin, liver fatty acid-binding protein, N-Acetyl-β-d-glucosaminidase, and α1-Acid-glycoprotein. We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as 2 consecutive visits of antihypertensive medication use. During a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher urine albumin-To-creatinine ratio was independently associated with incident hypertension (relative risk =1.13 per urine albumin-To-creatinine ratio doubling, 95% confidence interval, 1.07-1.20), as was lower estimated glomerular filtration rate (relative risk =1.10 per 10 mL/min/1.73 m2 lower estimated glomerular filtration rate; 95% confidence interval, 1.04-1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, urine albumin-To-creatinine ratio was not associated with incident hypertension, whereas higher urine interleukin-18, α1-Acid-glycoprotein, and N-Acetyl-β-d-glucosaminidase levels were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in HIV-infected people. The associations of tubular markers with hypertension in HIV-uninfected women should be validated in other studies.

Original languageEnglish (US)
Pages (from-to)304-313
Number of pages10
Issue number2
StatePublished - Feb 1 2017


  • HIV
  • albuminuria
  • glomerular filtration rate
  • hypertension
  • kidney disease

ASJC Scopus subject areas

  • Internal Medicine


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