TABLE 3.

Multivariable-adjusted associations of serum albumin with rapid kidney function decline and incident reduced eGFR in HIV-infected WIHS participants.

	Rapid Kidney Function Decline		Incident Reduced eGFRcys
	Adjusted IRR (95% CI)	P Value	Adjusted IRR (95% CI)	P Value
Continuous Predictors
Serum Albumin, per −0.5 g/dL less	1.71 (1.29, 2.26)	<0.001	1.72 (1.31, 2.25)	<0.001
ACR, per doubling	1.19 (1.09, 1.31)	<0.001	1.13 (1.00, 1.27)	0.04
Baseline eGFRcys, per 10 ml/min/1.73 m2 greater	0.98 (0.90, 1.07)	0.7	1.41 (1.22, 1.64)	<0.001
Dichotomized Predictors
Serum Albumin < 3.8 g/dL	2.13 (1.30, 3.49)	0.003	1.71 (1.05, 2.79)	0.03
ACR ≥ 30 mg/g	2.03 (1.28, 3.20)	0.002	1.95 (1.19, 3.20)	0.008
Baseline eGFRcys <60 ml/min/1.73 m2	1.05 (0.62, 1.77)	0.9	na***

Note: Rapid kidney function decline defined as 5% or more per year, using baseline and final eGFRcys. Results reported as relative risk of rapid kidney function decline or incident reduced eGFRcys (95% CI). Estimates are calculated from generalized estimating equation relative risk regression models. Models control for age, race, HIV RNA, CD4, HCV, DM, anti-retroviral therapy use, baseline eGFR, systolic and diastolic blood pressures, body mass index, ACR, and study site. For ACR as a predictor instead of adjusting for ACR the full model adjusts for serum albumin concentration.

Anti-retroviral therapy included current combination antiretroviral therapy use, current nucleoside reverse transcriptase inhibitor use, current non-nucleoside reverse transcriptase inhibitor use, and current protease inhibitor use.

^***Analysis of incident reduced eGFR excludes those with reduced eGFR at baseline. Model instead controls for continuous eGFR.

ACR, albumin-creatinine ratio; CI, confidence interval; eGFR, estimated glomerular filtration rate; eGFR_cys, cystatin C–based estimated glomerular filtration rate; IRR, incidence rate ratio; Women’s Interagency HIV Study (WIHS),