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

Ryom, L; Lundgren, JD; Ross, M; Kirk, O; Law, M; Morlat, P; Smit, C; ... D:A:D Study Group, .; + view all (2016) Renal Impairment and Cardiovascular Disease in HIV-positive Individuals; The D:A:D Study. Journal of Infectious Diseases , 214 (8) pp. 1212-1220. 10.1093/infdis/jiw342. Green open access

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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 HIV-positive individuals. METHODS: Individuals with >2 estimated glomerular filtration rate (eGFRs) after 1/2/2004 were followed until CVD, death, last visit plus six months or 1/2/2015. CVD was defined as centrally validated myocardial infarction, stroke, invasive cardiovascular procedures or sudden cardiac death. RESULTS: During 8.0 years median follow-up (Interquartile range 5.4-8.9) 1,357 of 35,357 developed CVD (incidence 5.2/1000 person-years [95%confidence interval, CI [5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% [95%CI 1.6-2.0%] estimated to develop CVD at five years at eGFR>90 ml/min/1.73m(2), increasing to 21.1% [95%CI 6.6-35.6%] at eGFR<30 ml/min/1.73m(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/min/1.73m(2) remained associated with 30-40% increased CVD rates and particular high rates at eGFR<30 ml/min/1.73m(2) (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, in particular in older individuals with continuously low eGFR.

Type: Article
Title: Renal Impairment and Cardiovascular Disease in HIV-positive Individuals; The D:A:D Study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/infdis/jiw342
Publisher version: http://doi.org/10.1093/infdis/jiw342
Language: English
Additional information: © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in the Journal of Infectious Diseases following peer review. The version of record Ryom, L; Lundgren, JD; Ross, M; Kirk, O; Law, M; Morlat, P; Smit, C; (2016) Renal Impairment and Cardiovascular Disease in HIV-positive Individuals; The D:A:D Study. Journal of Infectious Diseases , 214 (8) pp. 1212-1220. 10.1093/infdis/jiw342 is available online at: http://doi.org/10.1093/infdis/jiw342.
Keywords: eGFR; renal impairment; kidney disease; cardiovascular disease; myocardial infarction; stroke; invasive cardiovascular procedures; sudden cardiac death; HIV
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1508961
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