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Clinical Trial
. 2016 Jun 29:6:28741.
doi: 10.1038/srep28741.

Urinary albumin-to-creatinine ratio is associated with endothelial dysfunction in HIV-infected patients receiving antiretroviral therapy

Matteo Pirro  1 , Massimo R Mannarino  1 , Daniela Francisci  2 , Elisabetta Schiaroli  2 , Vanessa Bianconi  1 , Francesco Bagaglia  1 , Amirhossein Sahebkar  3   4 , Elmo Mannarino  1 , Franco Baldelli  2
Affiliations
Clinical Trial

Urinary albumin-to-creatinine ratio is associated with endothelial dysfunction in HIV-infected patients receiving antiretroviral therapy

Matteo Pirro et al. Sci Rep. .

Abstract

Endothelial dysfunction, a marker of cardiovascular (CV) risk, is common in human immunodeficiency virus (HIV)-infected patients. Microalbuminuria is frequent in HIV-infected patients, and is a predictor of renal impairment and CV risk. We investigated the association between microalbuminuria and endothelial dysfunction among HIV-infected patients receiving highly-active antiretroviral therapy (HAART). Endothelial function, measured by brachial artery flow-mediated dilatation (bFMD), and urine albumin-to-creatinine ratio (UACR), were measured in 170 HAART-treated HIV-infected adults. The relationship between UACR and bFMD was evaluated. The prevalence of increased UACR, defined by two cut-off levels (20 mg/g and 30 mg/g), was 29% and 17%. UACR was significantly higher while bFMD was lower among patients with metabolic syndrome (MS). UACR was associated with bFMD (r = -0.31; p < 0.001). This association was stronger in MS-patients (r = -0.44; p = 0.003). UACR above 20 mg/g was associated with an increased risk (OR 2.37, 95% CI 1.15-4.89, p = 0.020) of severely impaired bFMD (bFMD ≤ 2.1%). Patients with MS and increased UACR had the lowest bFMD compared with those with none or one of the two conditions. Microalbuminuria and endothelial dysfunction are positively associated in HIV-infected patients regardless of known confounders. The coexistence of microalbuminuria and MS amplifies their deleterious influence on endothelial function.

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Figures

Figure 1
Figure 1. Prevalence of patients with high urinary albumin to creatinine ratio (either >20 mg/g or >30 mg/g,) among patients either without metabolic syndrome (black bars) or with metabolic syndrome (grey bars).
*p < 0.001. UACR, urinary albumin to creatinine ratio. MS, metabolic syndrome.
Figure 2
Figure 2. Logarithmic transformed urinary albumin to creatinine ratio in patients grouped according to the presence of either metabolic syndrome, low brachial flow-mediated vasodilation (≤2.1%, corresponding to the 25th percentile among patients with normal urinary albumin to creatinine ratio) levels or both the conditions.
*p < 0.001; #p = 0.004; §p = 0.011. Lg, logarithmic transformed; UACR, urinary albumin to creatinine ratio; MS, metabolic syndrome; bFMD, brachial flow-mediated vasodilation.
Figure 3
Figure 3. Age- and gender-adjusted lg-bFMD in patients with or without metabolic syndrome.
*p = 0.015; Lg, logarithmic transformed; bFMD, brachial flow-mediated vasodilation; MS, metabolic syndrome.
See this image and copyright information in PMC

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