Dano precoce de glicocálice endotelial associado à disfunção renal em pacientes com HIV: um estudo de coorte prospectivo

Abstract

HIV patients present an increased risk for chronic kidney disease (CKD). Endothelial dysfunction has previously been associated with markers of renal dysfunction. This study aims to investigate the association between new biomarkers and kidney and endothelial damage in patients with HIV. Methods: Cohort study conducted with HIV patients on chronic use of antiretroviral therapy (ART), followed at a public outpatient service located in Northeastern Brazil. Clinical and laboratory parameters of patients with HIV were assessed year by year from 2015 (year 1) to 2019 (year 5). In 2015, biomarkers for renal damage (NGAL, MCP-1 and KIM-1) and for endothelial activation or glycocalyx damage (ICAM-1, E-selectin and syndecan-1) being used the method Enzyme-linked Immunosorbent Assay (ELISA). Their levels were used to classify patients into different groups. Among the 276 patients followed at the service, 70 were selected in the first year. A total of 66 patients concluded the five-year accompaniment follow-up. Most patients were male (77.3%), aged 33.7 ± 8.7 years in 2015 and 39.3 ± 9.0 years in 2019. None of the patients developed CKD. However, syndecan-1 was significantly correlated with maximum serum creatinine (p <0.001) and minimum estimated glomerular filtration rate (eGFR) (p = 0.003) over the studied years. Furthermore, both serum creatinine and eGFR for nearly five years were significantly associated with serum 2015 syndecan-1 levels. Multivariable linear regression with confounding factors presented a significant and independent association of eGFR and syndecan-1 levels and CD4 cell count at the study initiation, as well as age at 2015. Conclusions: HIV patients on chronic ART, with evidence of glycocalyx damage, are at increased risk of long-term renal dysfunction. The data support the screening of kidney diseases with new biomarkers, especially syndecan-1, as an important strategy for a timely diagnostic and therapeutic approach, aiming for the best results.