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Multicenter Study
. 2010 Feb 9;121(5):651-8.
doi: 10.1161/CIRCULATIONAHA.109.898585. Epub 2010 Jan 25.

Association between kidney function and albuminuria with cardiovascular events in HIV-infected persons

Andy I Choi  1 , Yongmei Li, Steven G Deeks, Carl Grunfeld, Paul A Volberding, Michael G Shlipak
Affiliations
Multicenter Study

Association between kidney function and albuminuria with cardiovascular events in HIV-infected persons

Andy I Choi et al. Circulation. .

Abstract

Background: Cardiovascular disease (CVD) is now a leading cause of death in HIV-infected persons; however, risk markers for CVD are ill defined in this population. We examined the association between longitudinal measures of kidney function and albuminuria with risk of atherosclerotic CVD and heart failure in a contemporary cohort of HIV-infected individuals.

Methods and results: We followed a national sample of 17 264 HIV-infected persons receiving care in the Veterans Health Administration for (1) incident CVD, defined as coronary, cerebrovascular, or peripheral arterial disease, and (2) incident heart failure. Rates of CVD and heart failure were at least 6-fold greater in the highest-risk patients with an estimated glomerular filtration rate (eGFR) <30 mL/min per 1.73 m(2) and albuminuria > or =300 mg/dL versus those with no evidence of kidney disease (eGFR > or =60 mL/min per 1.73 m(2) and no albuminuria). After multivariable adjustment, eGFR levels 45 to 59, 30 to 44, and <30 mL/min per 1.73 m(2) were associated with hazard ratios for incident CVD of 1.46 (95% confidence interval, 1.15 to 1.86), 2.03 (1.47 to 2.82), and 1.99 (1.46 to 2.70) compared with eGFR > or =60 mL/min per 1.73 m(2). Similarly, albuminuria levels 30, 100, and > or =300 mg/dL had hazard ratios for CVD of 1.28 (1.09 to 1.51), 1.48 (1.15 to 1.90), and 1.71 (1.30 to 2.27) compared with absent albuminuria. The associations between eGFR and albuminuria with heart failure were larger in magnitude and followed the same trends.

Conclusions: In this national sample of HIV-infected persons, eGFR and albuminuria levels were strongly associated with risk of CVD and heart failure. Kidney function and albuminuria provide complementary prognostic information that may aid CVD risk stratification in HIV-infected persons.

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Figures

Figure 1
Figure 1
Incidence Rates of Atherosclerotic Cardiovascular Events (Panel A) and Heart Failure (Panel B), Stratified by Estimated Glomerular Filtration Rate and Dipstick Albuminuria Level.
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