Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

Lene Ryom Nielsen; Jens D Lundgren; Mike Ross; Ole Kirk; Matthew Law; Philippe Morlat; Eric Fontas; Colette Smit; Christoph A Fux; Camilla Ingrid Hatleberg; Stephane De Wit; Caroline A Sabin; Amanda Mocroft

doi:10.1093/infdis/jiw342

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

Lene Ryom Nielsen, Jens D Lundgren, Mike Ross, Ole Kirk, Matthew Law, Philippe Morlat, Eric Fontas, Colette Smit, Christoph A Fux, Camilla Ingrid Hatleberg, Stephane De Wit, Caroline A Sabin, Amanda Mocroft

Department of Clinical Medicine

24 Citations (Scopus)

Abstract

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.

Original language	English
Journal	The Journal of Infectious Diseases
Volume	214
Issue number	8
Pages (from-to)	1212-1220
Number of pages	9
ISSN	0022-1899
DOIs	https://doi.org/10.1093/infdis/jiw342
Publication status	Published - 15 Oct 2016

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title = "Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study",

abstract = "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.",

author = "Nielsen, {Lene Ryom} and Lundgren, {Jens D} and Mike Ross and Ole Kirk and Matthew Law and Philippe Morlat and Eric Fontas and Colette Smit and Fux, {Christoph A} and Hatleberg, {Camilla Ingrid} and {De Wit}, Stephane and Sabin, {Caroline A} and Amanda Mocroft",

year = "2016",

month = oct,

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doi = "10.1093/infdis/jiw342",

language = "English",

volume = "214",

pages = "1212--1220",

journal = "The Journal of Infectious Diseases",

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TY - JOUR

T1 - Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals

T2 - The D:A:D Study

AU - Nielsen, Lene Ryom

AU - Lundgren, Jens D

AU - Ross, Mike

AU - Kirk, Ole

AU - Law, Matthew

AU - Morlat, Philippe

AU - Fontas, Eric

AU - Smit, Colette

AU - Fux, Christoph A

AU - Hatleberg, Camilla Ingrid

AU - De Wit, Stephane

AU - Sabin, Caroline A

AU - Mocroft, Amanda

PY - 2016/10/15

Y1 - 2016/10/15

N2 - 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.

AB - 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.

U2 - 10.1093/infdis/jiw342

DO - 10.1093/infdis/jiw342

M3 - Journal article

C2 - 27485357

SN - 0022-1899

VL - 214

SP - 1212

EP - 1220

JO - The Journal of Infectious Diseases

JF - The Journal of Infectious Diseases

IS - 8

ER -

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

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