Glomerular filtration rate and proteinuria associations with coronary artery calcium among HIV-infected and HIV-uninfected men in the Multicenter AIDS Cohort Study.
BACKGROUND
Decreased kidney function and greater albuminuria are associated with increased incidence and extent of coronary artery calcium (CAC). We investigated whether the associations between kidney function and urine protein-to-creatinine ratio (UPCR) with CAC differ by HIV serostatus.


METHODS
Using data from the Multicenter AIDS Cohort Study, a prospective multicenter US study of men who have sex with men, we carried out a cross-sectional study comprised of 592 HIV-infected (HIV+) and 378 uninfected (HIV-) men who underwent noncontrast computed tomography to measure CAC. Logistic and linear regression models were used to determine whether HIV infection modified associations of estimated glomerular filtration rate and UPCR with the presence and extent of CAC, adjusting for age, race, and cardiovascular risk factors.


RESULTS
Every 10 U decrease in estimated glomerular filtration rate below 90 ml/min/1.73 m was significantly associated with 1.3-fold [95% confidence interval (CI): 1.06-1.51] higher odds of CAC presence and was similar by HIV serostatus (Pinteraction=0.37). Greater UPCR was associated with more extensive CAC, with a change in log CAC score of 0.32 (95% CI: 0.10-0.55) per 1% increase in UPCR. There was a strong trend for effect modification by HIV serostatus for this association [HIV-: 0.75 (95% CI: 0.26-1.25); HIV+: 0.22 (95% CI: -0.03 to 0.47), Pinteraction=0.06].


CONCLUSIONS
Greater CAC burden is apparent among individuals with early kidney disease, irrespective of HIV serostatus. Increased UPCR is associated with a greater extent of CAC with a trend for differences by HIV serostatus; a clearer proteinuria/CAC extent relationship was apparent among HIV- patients.
aDepartment of Medicine, Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, California bDepartment of Medicine, Johns Hopkins University School of Medicine cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore dAstraZeneca, Gaithersburg, Maryland eDepartment of Infectious Diseases and Microbiology and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania fDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Sion K
SK
Roy
Michelle M
MM
Estrella
Annie T
AT
Darilay
Matthew J
MJ
Budoff
Lisa P
LP
Jacobson
Mallory D
MD
Witt
Lawrence A
LA
Kingsley
Wendy S
WS
Post
Frank J
FJ
Palella
D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
D015415:Biomarkers; D003404:Creatinine