Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study.
- Ryom L Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
- Lundgren JD Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
- Ross M Division of Nephrology, Mount Sinai School of Medicine, New York.
- Kirk O Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
- Law M Kirby Institute, University of New South Wales, Sydney, Australia.
- Morlat P Université Bordeaux, INSERM U 897, CHU de Bordeaux.
- Fontas E Nephrology Department, Public Health Department, CHU Nice, France.
- Smit C Academic Medical Center, Division of Infectious Diseases Department of Global Health, University of Amsterdam HIV Monitoring Foundation, Amsterdam, The Netherlands.
- Fux CA Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland.
- Hatleberg CI Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
- de Wit S Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium.
- Sabin CA Research Department of Infection and Population Health, University College London, United Kingdom.
- Mocroft A Research Department of Infection and Population Health, University College London, United Kingdom.
- 2016-08-04
Published in:
- The Journal of infectious diseases. - 2016
HIV
cardiovascular disease
eGFR
invasive cardiovascular procedures
kidney disease
myocardial infarction
renal impairment
stroke
sudden cardiac death
Adult
Cardiovascular Diseases
Female
Glomerular Filtration Rate
HIV Infections
Humans
Kidney
Male
Middle Aged
Myocardial Infarction
Prospective Studies
Renal Insufficiency
Risk Factors
Stroke
English
BACKGROUND
While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals.
METHODS
Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death.
RESULTS
During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m(2) estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m(2) The strong univariate relationship between low current eGFR and CVD was primarily explained by increasing age in adjusted analyses, although all eGFRs ≤ 80 mL/minute/1.73 m(2) remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m(2) (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]).
CONCLUSIONS
Among HIV-positive individuals in a large contemporary cohort, a strong relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.
While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals.
METHODS
Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death.
RESULTS
During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m(2) estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m(2) The strong univariate relationship between low current eGFR and CVD was primarily explained by increasing age in adjusted analyses, although all eGFRs ≤ 80 mL/minute/1.73 m(2) remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m(2) (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]).
CONCLUSIONS
Among HIV-positive individuals in a large contemporary cohort, a strong relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/infdis/jiw342
- PMID 27485357
- Persistent URL
- https://folia.unifr.ch/global/documents/212692
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