Kidney function and the risk of cardiovascular events in HIV-1-infected patients

Abstract

Objective: Cardiovascular events (CVEs) are a significant cause of mortality in HIV/AIDS patients. The objective is to determine the correlation between kidney function and the risk of CVEs in the HIV-infected population.

Design: Nested, matched, case-control study design was employed.

Methods: : We performed a single-center study of 315 HIV-infected patients (63 patients who had CVEs and 252 controls). Estimated glomerular filtration rate (eGFR), calculated by the Chronic Kidney Disease Epidemiology Collaboration formula and the Modification of Diet in Renal Disease equation, and proteinuria were the primary exposures of interest.

Results: Mean eGFR was significantly lower in the patients compared with controls (68.4 vs. 103.2 ml/min per 1.73 m, P < 0.001 by Chronic Kidney Disease Epidemiology Collaboration formula and 69.0 vs. 103.1 ml/min per 1.73 m, P < 0.001 by Modification of Diet in Renal Disease equation). In univariate analysis, an eGFR of less than 60 ml/min per 1.73 m was associated with a 15.9-fold increased odds of a CVE compared with an eGFR of at least 60 ml/min per 1.73 m (P < 0.001). In multivariate analysis, a 10 ml/min per 1.73 m decrease in eGFR was associated with a 20% increased odds of a CVE (odds ratio 1.2, 95% confidence interval 1.1-1.4). The prevalence of proteinuria in the patients was approximately twice that of controls (51 vs. 25%, P < 0.001). Proteinuria was associated with CVEs both in univariate and multivariate analyses (odds ratio 3.6, 95% confidence interval 1.9-7.0 and odds ratio 2.2, 95% confidence interval 1.1-4.8, respectively). Traditional cardiovascular risk factors, such as history of previous CVEs, diabetes mellitus, and dyslipidemia, along with low CD4 cell counts were also found as significant predictors of risk of CVEs.

Conclusion: Our study shows a significant independent association between decreased kidney function and increased risk of CVE in HIV-1-infected patients.

Figure 1

Relationship between estimated glomerular filtration rate (GFR) and cardiovascular event status in a nested, matched case-control study of HIV-infected subjects. The points correspond to individual subjects. The curve, generated by a locally-weighted regression smoothing function, represents cardiovascular disease risk according to estimated GFR.