Charles B. Hicks, MD reviewing Ryom L et al. J Infect Dis 2016 Oct 15.

A strong link between renal dysfunction and incident cardiovascular disease was identified in the D:A:D cohort.

The link between renal impairment and cardiovascular disease (CVD) in HIV-infected people has been suggested but not definitively established. Using longitudinal data from more than 35,000 HIV-positive people (48% white; 74% male; median age, 41 years) in the ongoing prospective, multinational D:A:D cohort study, investigators analyzed the relationship between estimated glomerular filtration rate (eGFR), measured by the Cockcroft–Gault method, and a first CVD event.

During a median 8 years of follow-up, 1646 centrally adjudicated CVD events occurred in 1357 persons. After 5 years, incident CVD was significantly more common among HIV-positive people with diminished eGFR, most notably among those with eGFR ≤30 mL/min/1.73m2 compared with those whose eGFR was >90 mL/min/1.73m2 (21% vs. 2%). Adjustment for increasing age explained much, but not all, of the relationship between eGFR and CVD. The elevated 5-year CVD risk associated with an eGFR ≤30 mL/min/1.73m2 remained significant, independent of age (incidence rate ratio, 4.21 [95% CI, 2.81–6.30], compared with eGFR >90 mL/min/1.73m2).

CITATION(S):

Ryom L et al. Renal impairment and cardiovascular disease in HIV-positive individuals: The D:A:D study. J Infect Dis 2016 Oct 15; 214:1212.

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