Renal impairment is associated with increased risk of cardiovascular disease (CVD) in individuals HIV positive, according to data from a large observational cohort study published in the online edition of the Journal of Infectious Diseases. Within five years of follow-up, more than one-fifth of people with severely impaired renal function developed cardiovascular disease compared with less than 2% of individuals with normal renal function. Even taking into account the age and side effects of antiretroviral drugs, severely impaired renal function remained associated with cardiovascular disease, with rates increasing by 30 to 40%.
“In this large and heterogeneous cohort of HIV-positive individuals we found a strong association between cardiovascular events and centrally adjudicated advanced levels of renal impairment, write the authors. “The high rates of CVD observed in older individuals with mild to moderate renal impairment and underline the need to intensify follow-up and the search for effective prophylactic measures to combat and prevent worsening renal function and consequent CVD in the aging of the HIV-positive population. "
The relationship between worsening renal function and cardiovascular disease is well established in the general population. However, studies to analyze the relationship between kidney and cardiovascular disease in people living with HIV have tended to be small and the relationship between estimated glomerular filtration rate (eGFR) - a marker of renal function - and cardiovascular disease. little explored.
To remedy this shortcoming knowledge, the data collection researchers about the adverse events of anti-HIV drugs have created (D: A: D), a study designed from a substudy to determine the relationship between the evaluation of renal function by eGFR and cardiovascular disease. The study D: A: D involves eleven large observational cohort in America, Europe and Australia.
People who had at least two eGFR measurements between 2004 and 2015 were eligible for inclusion. Cardiovascular disease was defined as validated if heart attack, stroke, invasive cardiovascular procedures or sudden cardiac death.
The study population consisted of about 35,357 individuals. They were predominantly white (48%), male sex (74%) and the mean age at baseline was 41 years.
There was a fairly high prevalence of cardiovascular risk factors: 42% were smokers, 4% had diabetes, hypertension 9% and slightly less than 1% had a previous cardiovascular event. The global average line of five-year risk of chronic kidney disease was only 0,3%, and the median risk of a cardiovascular event was 2%.
There was a clear relation between the line of age and renal function. Participants under the age of 40 years 87% (n = 13,660) had normal (eGFR> 90 ml / min / 1,73m2) baseline renal function and only 0,04% had advanced renal impairment (eGFR <30 / min / 1,73 m2) . In contrast, only 16% of participants aged 60 and older had normal renal function at baseline and 0,8% confirmed advanced renal impairment. The subjects were followed for an average period of eight years. During this time, 1357 1646 people have experienced cardiovascular events, an incidence of 5,2 1000 by person-years of follow-up.
The average EGFR before a cardiovascular event was significantly lower (eGFR 85ml / min / 1,73m2) in people who live in an event compared to those remained event-free (eGFR 94ml / min / 1,73m2). There was a clear relationship between baseline eGFR and incident cardiovascular disease events. Over five years of follow up, 2% of those with eGFR above 90 ml / min / 1,73m2 presented an event, rising to 4% of those with eGFR between 90 ml / min / 1,73m2, 11% of those with baseline eGFR between 30-60 ml / min / 1,73m2 and 21% of individuals with a line eGFR below 30 ml / min / 1,73m2. In the initial analysis, there was a strong relationship between the worsening of the baseline of the EGFR and the risk of cardiovascular disease, the incidence rate (IRR) increasing 1,00 in eGFR> 90 ml / min / 1,73m2 to 14.09 in eGFR <30ml / min / 1,73m2 . However, adjusting for age explained most of the relationship between EGFR and cardiovascular risk in eGFR levels above 30ml / min / 1,73m2.
However, all eGRF levels below 80ml / min / 1,73m2 were associated with a higher incidence of cardiovascular disease from approximately 30 to 40%. This finding remained essentially unchanged after adjustment for anti-HIV drug use associated with worsening renal function. Adjusting for the Framingham Risk Score - ten years for risk of a cardiovascular event - explained some of the relationships between current eGFR and cardiovascular events, but not to the same extent as age alone.
A more detailed analysis showed that people with higher scores risk of kidney disease in five years had a more than twofold increase more in its five-year risk of cardiovascular disease compared to individuals with a modest risk of medium-term kidney disease (RRI, 2,56, 95% CI, 2,22 95). The proportion of people with a cardiovascular event experienced a fatal cardiovascular event was strongly related to the current eGFR score, increasing from 4% for individuals with a current eGFR> 90 ml / min / 1,73m2 to 25% for those with a current eGFR <30ml / min / 1,73m2.
“In a large contemporary cohort of HIV-infected individuals, we observed a strong relationship between confirmation of worsening renal function and CVD impairment,” the authors conclude. "Our findings highlight the need for intensified control of emerging countries, particularly CVD in older individuals with continuously low eGFR levels."
Translated into 23 / 08 / 2016 by Claudio Souza from the original in Poor kidney function associated with Increased cardiovascular risk for people with HIV posted by Michael Carter at: 18 August 2016
Reviewed by Mara Macedo
Ryom L et al. renal impairment and cardiovascular disease in HIV-positive individuals; D: A: D study. J infect Dis, online edition, 2016.