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Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study.

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study.
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Ryom L, Lundgren JD, Ross M, Kirk O, Law M, Morlat P, Fontas E, Smit C, Fux CA, Hatleberg CI, de Wit S, Sabin CA, Mocroft A, ,


Ryom L, Lundgren JD, Ross M, Kirk O, Law M, Morlat P, Fontas E, Smit C, Fux CA, Hatleberg CI, de Wit S, Sabin CA, Mocroft A, , (click to view)

Ryom L, Lundgren JD, Ross M, Kirk O, Law M, Morlat P, Fontas E, Smit C, Fux CA, Hatleberg CI, de Wit S, Sabin CA, Mocroft A, ,

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The Journal of infectious diseases 2016 Aug 02214(8) 1212-20 doi 10.1093/infdis/jiw342

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 human immunodeficiency virus (HIV)-positive individuals.

METHODS
Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death.

RESULTS
During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m(2) estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m(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/minute/1.73 m(2) remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m(2) (incidence rate ratio, 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, particularly in older individuals with continuously low eGFRs.

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