Prevalence and influencing factors of kidney impairment in middle-aged and elderly people living with HIV
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摘要:
目的 探讨中老年人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者肾功能损伤的患病率及其影响因素，为该人群肾功能损伤的早期预防和干预提供科学依据。 方法 采用横断面研究设计，基于台州市HIV与衰老研究(comparative HIV and aging research in Taizhou, CHART)，纳入2022年1月―2024年7月基线调查时年龄为≥40岁的HIV感染者。根据慢性肾脏病流行病学合作研究(chronic kidney disease epidemiology collaboration, CKD-EPI)公式计算估计肾小球滤过率(estimated glomerular filtration rate, eGFR)，并根据eGFR进行肾功能分级。采用描述性统计分析研究对象的基本特征及肾功能损伤患病率，并采用多因素有序logistic回归模型分析肾功能损伤的影响因素。 结果 共纳入692名中老年HIV感染者，其中男性527名(76.16%)，女性165名(23.84%)，平均年龄为56(49，64)岁。轻度肾功能损伤患病率为23.55%(163/692)；中重度肾功能损伤患病率为3.61%(25/692)；合计肾功能损伤患病率为27.17%(188/692)。多因素有序logistic回归模型分析显示，年龄增长(55~＜70岁：aOR=3.75, 95% CI: 2.37~5.91; ≥70岁：aOR=29.47, 95% CI: 15.02~57.82)、连续3个月服药种数≥2种(aOR=1.96, 95% CI: 1.15~3.35)、血脂异常(aOR=1.67, 95% CI: 1.12~2.48)与肾功能损伤呈正相关。此外，高尿酸血症也与肾功能损伤呈正相关，且关联性随损伤程度增加而增强。与血清尿酸水平正常者相比，患高尿酸血症的中老年HIV感染者发生轻度及以上肾功能损伤的风险更高(aOR=2.81, 95% CI: 1.62~4.88)；而从肾功能正常或轻度损伤进展为中重度肾功能损伤的风险进一步增加(aOR=8.51, 95% CI: 3.44~21.07)。 结论 中老年HIV感染者肾功能损伤患病率较高，以轻度损伤为主。年龄增长、多重用药、血脂异常和高尿酸血症是肾功能损伤的影响因素。建议对中老年HIV感染者定期监测肾功能，通过早期筛查、合理用药和代谢调控等综合措施，降低肾脏损伤风险。 -
关键词:
- 中老年 /
- 人类免疫缺陷病毒感染 /
- 肾功能损伤 /
- 患病率
Abstract:Objective To investigate the prevalence and influencing factors of kidney impairment in middle-aged and elderly people living with human immunodeficiency virus(HIV; PLWH), and to provide scientific evidence for early prevention and intervention in this population. Methods A cross-sectional study was conducted based on the comparative HIV and aging research in Taizhou (CHART). PLWH aged 40 and above who participated in the baseline survey between January 2022 and July 2024 were enrolled. The estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Descriptive statistical analysis was used to assess participants′ baseline characteristics and the prevalence of kidney impairment, while multivariable ordinal logistic regression was applied to identify influencing factors. Results A total of 692 middle-aged and elderly PLWH were included, comprising 527 males (76.16%) and 165 females (23.84%), with a median age of 56 years (IQR: 49-64). The prevalence of mild and moderate-to-severe kidney impairment was 23.55% (163/692) and 3.61% (25/692), respectively, with an overall prevalence of 27.17% (188/692). Multivariable ordinal logistic regression analysis revealed that age (55- < 70 years: aOR=3.75, 95% CI: 2.37-5.91; ≥70 years: aOR=29.47, 95% CI: 15.02-57.82), long-term use of two or more non-antiretroviral drugs (aOR=1.96, 95% CI: 1.15-3.35) and dyslipidemia (aOR=1.67, 95% CI: 1.12-2.48) were significantly associated with kidney impairment. Additionally, hyperuricemia was positively associated with kidney impairment, with a stronger association observed as severity increased. Compared to individuals with normal serum uric acid levels, those with hyperuricemia had higher odds of developing mild or greater kidney impairment (aOR=2.81, 95% CI: 1.62-4.88), and even greater odds of progressing to moderate-to-severe impairment (aOR=8.51, 95% CI: 3.44-21.07). Conclusions The prevalence of kidney impairment is relatively high in middle-aged and elderly PLWH, with mild impairment being the most common. Age, polypharmacy, dyslipidemia, and hyperuricemia are key influencing factors. It is recommended to regularly monitor renal function in middle-aged and elderly PLWH and implement comprehensive measures such as early screening, rational medication use, and metabolic regulation to reduce the risk of kidney damage. -
Key words:
- Elderly /
- Human immunodeficiency virus /
- Kidney impairment /
- Prevalence
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表 1 中老年HIV感染者基本特征及肾功能损伤患病率
Table 1. Basic characteristics and prevalence of kidney impairment among middle-aged and older people living with HIV
变量
Variable合计
Total/%肾功能正常
Normal kidney
function②轻度肾损伤
Mild kidney
impairment②中重度肾损伤
Moderate-to-severe
kidney impairment②χ2值
valueP值
value年龄组/岁Age group/years 145.56 ＜0.001 40~＜55 306(44.22) 272(88.89) 31(10.13) 3(0.98) 55~＜70 320(46.24) 219(68.44) 90(28.13) 11(3.44) ≥70 66(9.54) 13(19.70) 42(63.64) 11(16.67) 性别Gender 0.06 0.971 女Female 165(23.84) 119(72.12) 40(24.24) 6(3.64) 男Male 527(76.16) 385(73.06) 123(23.34) 19(3.61) 文化程度Education level 16.70 ＜0.001 初中及以上Junior high school or above 270(39.02) 216(80.00) 52(19.26) 2(0.74) 小学及以下Primary school or below 422(60.98) 288(68.25) 111(26.30) 23(5.45) 吸烟Smoking 0.98 0.612 否No 406(58.67) 291(71.67) 101(24.88) 14(3.45) 是Yes 286(41.33) 213(74.48) 62(21.68) 11(3.85) 饮酒频率(过去1年) Frequency of alcohol consumption(in the past year) 4.10 0.128 ＜1次/月＜1 time/month 429(61.99) 305(71.10) 111(25.87) 13(3.03) ≥1次/月≥1 time/month 263(38.01) 199(75.67) 52(19.77) 12(4.56) BMI/(kg·m-2) 4.56 0.335 18.5~＜24.0 404(58.38) 293(72.52) 98(24.26) 13(3.22) ＜18.5 36(5.20) 22(61.11) 11(30.56) 3(8.33) ≥24.0 252(36.42) 189(75.00) 54(21.43) 9(3.57) 中心性肥胖Central obesity 2.90 0.234 否No 437(63.15) 318(72.77) 107(24.49) 12(2.75) 是Yes 255(36.85) 186(72.94) 56(21.96) 13(5.10) 连续3个月服药种数/种Medications taken for ≥3 months /types① /③ ＜0.001③ 0 479(69.22) 368(76.83) 101(21.09) 10(2.09) 1 120(17.34) 79(65.83) 35(29.17) 6(5.00) ≥2 93(13.44) 57(61.29) 27(29.03) 9(9.68) 高血压Hypertension 12.19 0.002 否No 437(63.15) 336(76.89) 91(20.82) 10(2.29) 是Yes 255(36.85) 168(65.88) 72(28.24) 15(5.88) 糖尿病Diabetes 2.04 0.361 否No 589(85.12) 433(73.51) 137(23.26) 19(3.23) 是Yes 103(14.88) 71(68.93) 26(25.24) 6(5.83) 血脂异常Dyslipidemia 3.33 0.190 否No 454(65.61) 339(74.67) 102(22.47) 13(2.86) 是Yes 238(34.39) 165(69.33) 61(25.63) 12(5.04) 高尿酸血症Hyperuricemia 36.20 ＜0.001 否No 598(86.42) 450(75.25) 136(22.74) 12(2.01) 是Yes 94(13.58) 54(57.45) 27(28.72) 13(13.83) CD4+T淋巴细胞计数CD4+ T-cell count/(cells·μL-1) 0.57 0.750 ≥350 332(47.98) 246(74.10) 74(22.29) 12(3.61) < 350 360(52.02) 258(71.67) 89(24.72) 13(3.61) 接受抗逆转录病毒治疗Receiving antiretroviral therapy 0.33 0.848 否No 142(20.52) 104(73.24) 34(23.94) 4(2.82) 是Yes 550(79.48) 400(72.73) 129(23.45) 21(3.82) 注：HIV，人类免疫缺陷病毒。
①药物为非ART药物；②以人数(患病率/%)表示；③使用Fisher精确检验。
Note: HIV, human immunodeficiency virus.
① Medications refer to non-ART drugs; ② Number of people(proportion/%); ③ Fisher′s exact test was used.
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表 2 中老年HIV感染者肾功能损伤影响因素logistic回归分析
Table 2. Logistic regression analysis of factors associated with kidney impairment among middle-aged and older people living with HIV
变量
Variable单因素分析Univariate analysis 多因素分析Multivariate analysis OR值value(95% CI) P值value aOR值value(95% CI) P值value 年龄组/岁Age group/years 40~＜55 1.00 1.00 55~＜70 3.71(2.44~5.75) < 0.001 3.75(2.37~5.91) < 0.001 ≥70 28.31(15.42~53.48) < 0.001 29.47(15.02~57.82) < 0.001 性别Gender 女Female 1.00 1.00 男Male 0.96(0.65~1.42) 0.820 0.72(0.46~1.13) 0.148 文化程度Education level 初中及以上Junior high school or above 1.00 1.00 小学及以下Primary school or below 1.93(1.35~2.78) < 0.001 1.22(0.81~1.85) 0.347 吸烟Smoking 否No 1.00 是Yes 0.88(0.62~1.23) 0.453 饮酒频率(过去1年) Frequency of alcohol consumption(in the past year) ＜1次/月＜1 time/month 1.00 ≥1次/月≥1 time/month 0.82(0.57~1.15) 0.254 BMI/(kg·m-2) 18.5~＜24.0 1.00 1.00 ＜18.5 1.76(0.85~3.49) 0.114 1.78(0.78~4.02) 0.168 ≥24.0 0.89(0.62~1.27) 0.519 0.69(0.46~1.05) 0.081 中心性肥胖Central obesity 否No 1.00 是Yes 1.02(0.72~1.44) 0.893 连续3个月服药种数/种Medications taken for ≥3 months /types① 0 1.00 1.00 1 1.74(1.13~2.66) 0.011 1.32(0.80~2.18) 0.284 ≥2 2.25(1.40~3.58) ＜0.001 1.96(1.15~3.35) 0.013 高血压Hypertension 否No 1.00 1.00 是Yes 1.76(1.25~2.47) 0.001 1.15(0.76~1.74) 0.518 糖尿病Diabetes 否No 1.00 是Yes 1.28(0.81~2.00) 0.281 血脂异常Dyslipidemia 否No 1.00 1.00 是Yes 1.33(0.94~1.87) 0.109 1.67(1.12~2.48) 0.012 高尿酸血症Hyperuricemia② 否No 1.00 是Yes③ 2.25(1.44~3.53) < 0.001 2.81(1.62~4.88) < 0.001 是Yes④ 7.84(3.46~17.76) < 0.001 8.51(3.44~21.07) < 0.001 CD4+T淋巴细胞计数CD4+ T-cell count /(cells·μL-1) ≥350 1.00 < 350 1.12(0.81~1.57) 0.492 接受抗逆转录病毒治疗Receiving antiretroviral therapy 否No 1.00 是Yes 1.04(0.69~1.59) 0.856 注：HIV，人类免疫缺陷病毒。
①药物为非ART药物；②变量不满足比例优势假设，采用非比例优势模型；③统计结果反映肾功能正常与肾功能轻度及以上损伤的优势比；④统计结果反映肾功能正常或轻度损伤与肾功能中重度损伤的优势比。
Note: HIV, human immunodeficiency virus.
① Medications refer to non-ART drugs; ② The variable did not meet the proportional odds assumption; a non-proportional odds model was used; ③ The statistical result reflects the odds ratio comparing normal kidney function with mild or greater impairment; ④ The statistical result reflects the odds ratio comparing normal or mild impairment with moderate-to-severe kidney impairment.
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