The association of adiposity with kidney function decline among HIV-infected adults: findings from the Fat Redistribution and Metabolic Changes in HIV Infection (FRAM) study

ObjectivesThe aim of the study was to investigate the association of adiposity with longitudinal kidney function change in 544 HIV-infected persons in the Study of Fat Redistribution and Metabolic Change in HIV infection (FRAM) cohort over 5 years of follow-up. MethodsThe regional distribution of muscle and adipose tissue was quantified by whole-body magnetic resonance imaging (MRI), and total adiponectin and leptin levels were measured in serum. Kidney function was assessed using the estimated glomerular filtration rate from serum cystatin C (eGFRCys), obtained at baseline and follow-up. Rapid kidney function decline was defined as annual loss of eGFRCys3mL/min/1.73m(2), and incident chronic kidney disease (CKD) was defined as eGFRCys<60mL/min/1.73m(2). Multivariate regression analysis was adjusted for age, race, gender, glucose, antihypertensive use, serum albumin, baseline and change in HIV viral load. ResultsAt baseline, mean age was 43 years, mean eGFRCys was 86mL/min/1.73m(2), and 21% of patients had albuminuria. The mean (standard deviation) eGFRCys decline was -0.11 +/- 4.87mL/min/1.73m(2) per year; 23% of participants had rapid kidney function decline, and 10% developed incident CKD. The lowest tertile of visceral adipose tissue and the highest tertile of adiponectin were both marginally associated with annual kidney function decline of -0.5mL/min/1.73m(2) each, but these associations were not statistically significant after adjustment. We found no statistically significant associations of MRI-measured regional adiposity or serum adipokines with rapid kidney function decline or incident CKD (all P-values>0.1 in adjusted models). ConclusionsContrary to findings in the general population, adiposity did not have a substantial association with longitudinal change in kidney function among HIV-infected persons.