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Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study
Lene Ryom1, Jens D Lundgren1, Mike Ross2
1Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Cardiovascular disease (CVD) risk is significantly higher in human immunodeficiency virus (HIV)-positive individuals with impaired kidney function (eGFR). This highlights the need for proactive renal care and vigilant CVD monitoring in this population.
Area of Science:
- Nephrology
- Cardiology
- Infectious Diseases (HIV/AIDS)
Background:
- The link between kidney disease and cardiovascular disease (CVD) is established in the general population but less understood in individuals with human immunodeficiency virus (HIV).
- Understanding this association is crucial for managing cardiovascular risk in HIV-positive individuals.
Purpose of the Study:
- To investigate the relationship between estimated glomerular filtration rate (eGFR), a measure of kidney function, and the incidence of CVD in a large cohort of HIV-positive individuals.
- To identify specific risk factors and inform preventive strategies for CVD in this population.
Main Methods:
- A cohort of 35,357 HIV-positive individuals with at least two eGFR measurements after February 2004 were followed until February 2015.
- CVD outcomes included myocardial infarction, stroke, cardiovascular procedures, and sudden cardiac death, all centrally validated.
Main Results:
- A total of 1357 CVD cases occurred over a median follow-up of 8.0 years (incidence rate: 5.2/1000 person-years).
- A strong association was observed between lower eGFR and increased CVD risk; individuals with eGFR ≤ 30 mL/minute/1.73 m(2) had a 3-fold higher CVD incidence rate compared to those with eGFR > 90.
- While age was a significant factor, all eGFRs ≤ 80 mL/minute/1.73 m(2) remained independently associated with elevated CVD risk.
Conclusions:
- A significant association exists between impaired kidney function (low eGFR) and increased CVD risk in HIV-positive individuals.
- These findings underscore the importance of implementing renal protective measures and intensified CVD monitoring, especially in older HIV-positive individuals with persistently low eGFR.
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.
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