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Renal Impairment and Cardiovascular Disease in HIV-positive Individuals;
The D:A:D Study
 
 
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from Jules: HIV causes metabolic disorders for patients, they are all tied together: bone/heart/brain/cancers and related to dysfunctional immune system & disrupted metabolic - in conjunction with increased & accelerated aging & geriatric conditions as patients age leading to our current & what will be a worsening situation for older aging HIV+
 
CROI 2015
 
below excerpted from

 
The Kidney at CROI 2015 - Written by Lene Ryom PhD CHIP, Department of Infectious Diseases and Rheumatology, Section 2100, Rigshospitalet - University of Copenhagen, Denmark Christina Wyatt MD Associate Professor, Medicine/ Nephrology Icahn School of Medicine at Mount Sinai New York, NY - (03/06/15)
 
CKD as a predictor of cardiovascular disease
 
Several abstracts reinforced the strong association between CKD and adverse cardiovascular outcomes in HIV-positive adults. Analyses from two large cohorts, D:A:D and NA-ACCORD, demonstrated a strong association between CKD and cardiovascular events. Among 34,793 individuals in the D:A:D cohort, Ryom et al. observed that by five years almost one in four with eGFR<30 were estimated to have developed a centrally adjudicated cardiovascular event, with an increasing 28-day fatality rate as eGFR levels declined [Abstract 742] . While the association between eGFR and cardiovascular events was largely explained by older age at higher eGFR levels, the association with eGFR < 30 remained strong in fully adjusted models.
 
CROI: Confirmed kidney deficit tied to rising cardiovascular disease incidence in D:A:D......."need intensified monitoring for all types of emerging cardiovascular disease, in particular in older individuals with continuously low eGFR levels, and cincreased focus on applying different renal and cardiovascular preventive measures in HIV-positive persons" - (03/11/15) Drozd et al. described risk factors for acute myocardial infarction (MI) in 24,919 participants in NA-ACCORD, distinguishing primary MI attributed to acute coronary plaque rupture (n=262) from MI secondary to increased demand. All MI cases were centrally adjudicated. In adjusted analysis, Stage 4-5 CKD (eGFR < 30) was a significant independent predictor of primary myocardial infarction [Abstract 748].
 
CROI: Incidence and Risk of Myocardial Infarction (MI) by Type in the NA-ACCORD - (03/23/15)
 
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Renal Impairment and Cardiovascular Disease in HIV-positive Individuals; The D:A:D Study
 
Journal of Infectious Diseases Advance Access published August 2, 2016-
 
Lene Ryom1, Jens D. Lundgren1, Mike Ross2, Ole Kirk1, Matthew Law3, Philippe Morlat4, Colette Smit5, Eric Fontas6, Christoph A. Fux7, Camilla I. Hatleberg1, St├ęphane de Wit8, Caroline A. Sabin9 and Amanda Mocroft9, for the D:A:D Study Group
 
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/1.73m2, increasing to 21.1% [95%CI 6.6-35.6%] at eGFR<30 ml/min/1.73m2. 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/1.73m2 remained associated with 30-40% increased CVD rates and particular high rates at eGFR<30 ml/min/1.73m2 (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.

 
 
 
 
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