Kidney function and the risk of cardiovascular events in HIV-1-infected patients

George, Elizabeth C; Lucas, Gregory M.; Nadkarni, Girish N.; Fine, Derek M.; Moore, Richard; Atta, Mohamed G.

doi:10.1097/qad.0b013e3283359253

Cited by 78 publications

(54 citation statements)

References 30 publications

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“…Interestingly, we found that current or recent use of abacavir was associated with CKD. Abacavir has been associated with a higher risk of cardiovascular events (CVE) (29), and a recent study showed a significant independent association between decreased kidney function and increased risk of CVE in HIV-infected patients (30). Further studies are needed to confirm whether abacavir is associated with CKD and whether it is associated with CVE through the kidney function.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Flandre¹,

Puglièse²,

Cuzin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients.Design, setting, participants, & measurements Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR Յ60 ml/min per 1.73 m 2 over Ն3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD.Results From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] ϭ 2.40) and hypertension (HR ϭ 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count Ͼ200 cells/mm 3 had a lower risk of CKD (HR ϭ 0.63). Recent exposure to indinavir (HR ϭ 2.03), totenofovir (HR ϭ 1.55), and abacavir (HR ϭ 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR ϭ 2.23), and a trend toward significance was observed for past exposure to indinavir (HR ϭ 1.28).Conclusions CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Flandre¹,

Puglièse²,

Cuzin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…As such, >50% of all deaths among individuals with end-stage renal disease are related to a CVD event [7]. In contrast, most prior studies that have investigated the relation between renal impairment and CVD in human immunodeficiency virus (HIV)-positive individuals have been small, have used relatively broad definitions of CVD, or have focused on single measures of renal function, which are subjected to random variation and the transient effects of acute illness [8][9][10][11][12][13]. The influence of a more sustained impairment of the estimated glomerular filtration rate (eGFR) on well-defined CVD events in HIVpositive individuals is less clear.…”

mentioning

confidence: 91%

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

et al. 2016

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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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“…[1][2][3] A paucity of data, however, exists on the worldwide prevalence of CKD in this patient population. Cross-sectional studies from 31 European countries, Israel, and Argentina estimate the prevalence of CKD between 3.5% and 4.7% among HIVinfected individuals depending on the formula used to estimate GFR.…”

mentioning

confidence: 99%

APOL1 Risk Variants Predict Histopathology and Progression to ESRD in HIV-Related Kidney Disease

Fine¹,

Wasser

Estrella³

et al. 2012

Journal of the American Society of Nephrology

110

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With earlier institution of antiretroviral therapy, kidney diseases other than HIV-associated nephropathy (HIVAN) predominate in HIV-infected persons. Outcomes for these diseases are typically worse among those infected with HIV, but the reasons for this are not clear. Here, we examined the role of APOL1 risk variants in predicting renal histopathology and progression to ESRD in 98 HIV-infected African Americans with non-HIVAN kidney disease on biopsy. We used survival analysis to determine time to ESRD associated with APOL1 genotype. Among the 29 patients with two APOL1 risk alleles, the majority (76%) had FSGS and 10% had hypertensive nephrosclerosis. In contrast, among the 54 patients with one APOL1 risk allele, 47% had immune-complex GN as the predominant lesion and only 23% had FSGS. Among the 25 patients with no APOL1 risk allele, 40% had immune-complex GN and 12% had FSGS. In 310 person-years of observation, 29 patients progressed to ESRD. In adjusted analyses, individuals with two APOL1 risk alleles had a nearly three-fold higher risk for ESRD compared with those with one or zero risk alleles (P=0.03). In summary, these data demonstrate an association between APOL1 variants and renal outcomes in non-HIVAN kidney disease, suggesting a possible use for APOL1 genotyping to help guide the care of HIV-infected patients.

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Kidney function and the risk of cardiovascular events in HIV-1-infected patients

Cited by 78 publications

References 30 publications

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

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

APOL1 Risk Variants Predict Histopathology and Progression to ESRD in HIV-Related Kidney Disease

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