Albuminuria is a key biomarker for cardiovascular disease and chronic kidney disease. Our study aimed to describe the prevalence of albuminuria amongst people who inject drugs in London and to test any potential associations with demographic characteristics, past diagnoses, and drug preparation and administration practices. We carried out a cross-sectional survey amongst people who use drugs in London. The main outcome measure was any albuminuria including both microalbuminuria and macroalbuminuria. Three-hundred and sixteen samples were tested by local laboratory services. Our study initially employed point-of-care testing methods but this resulted in a high number of false positives. Our findings suggest the prevalence of albuminuria amongst PWID is twice that of the general population at 19% (95%CI 15.3–24.0%). Risk factors associated with albuminuria were HIV (aOR 4.11 [95% CI 1.37–12.38]); followed by overuse of acidifier for dissolving brown heroin prior to injection (aOR 2.10 [95% CI 1.04–4.22]). Albuminuria is high amongst people who inject drugs compared to the general population suggesting the presence of increased cardiovascular and renal pathologies. This is the first study to demonstrate an association with acidifier overuse. Dehydration may be common amongst this population and may affect the diagnostic accuracy of point-of-care testing for albuminuria.
Bibliographical noteFunding Information:
Dr. McGowan reports personal fees from European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) outside the submitted work. Dr. Nitsch reports other grants from Glaxo Smith Kline, outside the submitted work. Dr. Scott reports other from Turning Point, other from Cognisant Research, non-financial support from Academy of Medical Sciences, grants from Medical Research Council, grants from Pharmacy Research UK, outside the submitted work. Dr. Ciccarone reports grants from the US National Institutes of Heath, National Institute on Drug Abuse, during the conduct of the study; personal fees from Malinckrodt, personal fees from Nektar Therapeutics, personal fees from Celero Systems, personal fees from American Association for the Advancement of Science, outside the submitted work. The remaining authors declare no competing interests.
We would like to thank all service users and staff at the following services: Margarete Centre, Lorraine Hewitt House, Better Lives, Response, Find & Treat, Turning Point (Hammersmith, Chelsea & Kensington, and Westminster). Thank you also to Kate Johnstone and Harry Clark from the Camden and Islington research team for their help with recruitment. Additional thanks to Jim Conneely for his ongoing support for the study. Thank you also to Drs Shirley Huchcroft and Louisa Baxter for their advice on the analysis. Finally, we would like to reiterate our gratitude to our research participants who have been exceptionally generous with their time. The study was funded by the UK National Institute for Health Research (CDF-2016–09–014). The funder did not play a role in: the development of the study design; the collection, analysis, and interpretation of data; or the writing of the manuscript and the decision to submit the manuscript for publication. All authors, both internal and external, had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Magdalena Harris is funded by a National Institute for Health Research (NIHR), Career Development Fellowship for this research project. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Dr Ciccarone acknowledges research funding support from the US National Institutes of Health, National Institute on Drug Abuse (R01DA037820).
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