title: Incipient renal impairment as a predictor of subclinical atherosclerosis in HIV-infected patients.
abstract: BACKGROUND
  HIV-infected patients present increased incidence of cardiovascular disease (CVD). Although incipient kidney function impairment has been associated with CVD in the general population, this association has not been properly addressed in HIV-infected patients. We assessed the relationship between incipient renal impairment (IRI) and subclinical atherosclerosis in HIV-infected patients.
  
  
  METHODS
  Estimated glomerular filtration rate (eGFR), carotid intima-media thickness (cIMT), and cardiovascular biomarkers were measured in 145 HIV-infected patients. IRI was defined as a composite variable: eGFR <90 mL/min, rate of eGFR decrease >3% annually over a period of 3 years, and albumin/creatinine urine ratio above the median (≥5 mg/g). Individuals with a cIMT ≥75th percentile or plaque were classified as having subclinical atherosclerosis.
  
  
  RESULTS
  Ninety-five patients (64.1%) met the criteria for IRI. As for HIV-related factors, patients with IRI more frequently had lipodystrophy (41.3% vs. 21.6%; P = 0.017), a lower CD4 lymphocyte nadir [210 (125-343) vs. 302 (178-408) cells/mL; P = 0.046], and longer exposure to nucleoside reverse transcriptase inhibitors [187 (84-259) vs. 104 (34-170) months; P = 0.001], to nonnucleoside reverse transcriptase inhibitors [32 (7-77) vs. 20 0-40) months; P = 0.043], and to protease inhibitors [42 (0-115] vs. 2.5 (0-59) months; P = 0.007]. Patients with IRI more frequently had subclinical atherosclerosis (40.7% vs. 13.7%; odds ratio: 4.3; 95% confidence interval: 1.8 to 10.6; P = 0.001), even after adjustment for cardiovascular and HIV-related parameters (odds ratio: 3.8; 95% confidence interval: 1.3 to 11; P = 0.012).
  
  
  CONCLUSIONS
  The presence of IRI is an independent predictor of increased cIMT in HIV-infected patients and may help to identify patients with subclinical atherosclerosis and, therefore, increased risk of CVD.
authors: Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain. serranovillar@gmail.com
authors: Sergio
authors: S
authors: Serrano-Villar
authors: Vicente
authors: V
authors: Estrada
authors: Dulcenombre
authors: D
authors: Gómez-Garre
authors: Mario
authors: M
authors: Ávila
authors: Manuel
authors: M
authors: Fuentes-Ferrer
authors: Clara
authors: C
authors: Sánchez-Parra
authors: Talía
authors: T
authors: Sainz
authors: Ramón
authors: R
authors: Patiño
authors: Arturo
authors: A
authors: Fernández-Cruz
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D013030:Spain
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein