328 Urine Biomarker Predictors of Incident Hospitalization in People Living with HIV

Abstract

OBJECTIVES/GOALS: This study aims to determine 1) which urine biomarkers of kidney health measured in the ambulatory setting predict incident hospitalization; 2) to determine whether time-updated measures of ambulatory urine biomarkers and their changes/trajectories have added value over baseline alone. METHODS/STUDY POPULATION: Participants in the Predictors of Acute Renal Injury Study (PARIS), a prospective cohort of 478 HIV+ patients followed at the Johns Hopkins HIV Clinic, had sociodemographic, clinical data, and biosamples taken until hospitalization or up to 3 years annually. Among those hospitalized, clinical data and biosamples were collected serially during hospitalization and at 3 and 12 months post-discharge. For each of the 10 biomarkers measured, we will evaluate the association of the biomarker and risk of incident hospitalization using Cox hazards regression, adjusting for sociodemographics, comorbidities, HIV history, and medications. Biomarkers will be evaluated at baseline and as time-updated and change over time. RESULTS/ANTICIPATED RESULTS: We anticipate that higher baseline levels and increasing levels of urine albumin, α1M, β2M, NGAL, IL-18, KIM-1, MCP-1, YKL-40 will be independently associated with increased risk of incident hospitalization whereas higher and increasing levels of uromodulin and EGF will be associated with lower risk of incident hospitalization. These biomarkers collectively capture the following dimensions of kidney health: endothelial injury, tubular injury and function, inflammation, and fibrosis. We anticipate increased risk of incident hospitalization in HIV+ persons in the highest tertile of baseline, time-updated, and change over time biomarkers, relative to those within the lowest tertile. DISCUSSION/SIGNIFICANCE: This study will improve our understanding of the evolution of biomarkers of kidney health from the ambulatory to the hospitalized setting and will quantify the clinical implications of subclinical kidney damage among people living with HIV, a high-risk patient population with unique kidney pathophysiology.