title: Reduced kidney function and preclinical atherosclerosis in HIV-infected individuals: the study of fat redistribution and metabolic change in HIV infection (FRAM).
abstract: OBJECTIVE
  Reduced kidney function and albuminuria are associated with higher risk for cardiovascular disease (CVD) and mortality in HIV-infected individuals. We investigated whether reduced estimated glomerular filtration rate (eGFR) and albuminuria are associated with subclinical vascular disease, as assessed by carotid intima-medial thickness (cIMT).
  
  
  METHODS
  Cross-sectional analysis of 476 HIV-infected individuals without clinical evidence of CVD enrolled in the Fat Redistribution and Metabolic Change in HIV infection (FRAM) study, using multivariable linear regression. eGFR(Cys) and eGFR(Cr) were calculated from cystatin C and creatinine levels. Albuminuria was defined as a positive urine dipstick (≥ 1+) or urine albumin-to-creatinine ratio ≥ 30 mg/g. Common and internal cIMT were measured by high-resolution B-mode ultrasound.
  
  
  RESULTS
  In unadjusted analyses, eGFR(Cys) and eGFR(Cr) were strongly associated with com- mon and internal cIMT. Each 10 ml/min/1.73 m2 decrease in eGFR(Cys) and eGFR(cr) was associated with a 0.008 mm higher common cIMT (p = 0.003, p = 0.01) and a 0.024 and 0.029 mm higher internal cIMT (p = 0.003), respectively. These associations were eliminated after adjustment for age, gender, and race. Albuminuria showed little association with common or internal cIMT in all models.
  
  
  CONCLUSIONS
  In HIV-infected individuals without prior CVD, reduced kidney function and albuminuria were not independently associated with subclinical vascular disease, as assessed by cIMT. These results suggest that research should focus on searching for novel mechanisms by which kidney disease confers cardiovascular risk in HIV-infected individuals.
authors.affiliation: University of California, San Francisco, Calif., USA.
authors.forename: Vasantha
authors.initials: V
authors.lastname: Jotwani
authors.forename: Rebecca
authors.initials: R
authors.lastname: Scherzer
authors.forename: Andy
authors.initials: A
authors.lastname: Choi
authors.forename: Lynda
authors.initials: L
authors.lastname: Szczech
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000419:Albuminuria / Q000378:metabolism / Q000473:pathology; D050197:Atherosclerosis / Q000150:complications*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome