title: Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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]).
  
  
  
  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.
authors.affiliation: Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
authors.affiliation: Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.affiliation: Division of Nephrology, Mount Sinai School of Medicine, New York.
authors.forename: Mike
authors.initials: M
authors.lastname: Ross
authors.affiliation: Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.affiliation: Université Bordeaux, INSERM U 897, CHU de Bordeaux.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
authors.affiliation: Nephrology Department, Public Health Department, CHU Nice, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Fontas
authors.affiliation: Academic Medical Center, Division of Infectious Diseases Department of Global Health, University of Amsterdam HIV Monitoring Foundation, Amsterdam, The Netherlands.
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.affiliation: Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Fux
authors.affiliation: Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Camilla I
authors.initials: CI
authors.lastname: Hatleberg
authors.affiliation: Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: de Wit
authors.affiliation: Research Department of Infection and Population Health, University College London, United Kingdom.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.affiliation: Research Department of Infection and Population Health, University College London, United Kingdom.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000821:virology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000821:virology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000821:virology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology* / Q000821:virology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000821:virology
keywords: HIV; cardiovascular disease; eGFR; invasive cardiovascular procedures; kidney disease; myocardial infarction; renal impairment; stroke; sudden cardiac death