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Race and Other Risk Factors for Incident Proteinuria in a National Cohort of HIV-infected Veterans
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    Proteinuria in HIV-infected individuals has been associated with poorer outcomes. We examined risk factors associated with the development of proteinuria in a national registry of HIV-infected veterans.


    21,129 HIV-infected veterans of black and white race without pre-existing kidney disease were receiving health care in the Veterans’ Health Administration (VHA) medical system between 1997 and 2011. Using the VHA electronic record system, we identified kidney-related risk factors (hypertension, diabetes, cardiovascular disease), and HIV-related risk factors (CD4 lymphocyte count, HIV RNA level, hepatitis C virus, and hepatitis B virus) for developing proteinuria. Proteinuria was defined by 2 consecutive dipstick measures of 1+ or higher. The Fine-Gray competing risk model was used to estimate association between clinical variables and incident proteinuria, while accounting for intervening mortality events.


    During follow-up (median=5.3 years), 7,031 patients developed proteinuria. Overall, black race compared with white race was associated with a higher risk of proteinuria (HR[95% CI]=1.51[1.43–1.59]), but the association was stronger at younger ages (p interaction<0.001). Age-stratified risk of proteinuria for blacks relative to whites was greatest amongst veterans<30 years (2.19[1.66–2.89]) and the risk diminished with increasing age (1.14[0.97–1.34] for >60 years). We found the race difference to be stronger for the outcome of 2+ or higher proteinuria (2.13[1.89–2.39]). Both HIV-related and traditional risk factors were also associated with incident proteinuria (p<0.05).


    Compared with whites, risk of proteinuria was higher in black veterans with HIV-infection, particularly at younger ages. In both races, HIV and kidney-related risk factors were associated with higher proteinuria risk.

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    1U58DP003839/DP/NCCDPHP CDC HHS/United States
    R01 AG034853/AG/NIA NIH HHS/United States
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