Reduced Kidney Function and Preclinical Atherosclerosis in HIV-Infected Individuals: The Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM)
Reduced Kidney Function and Preclinical Atherosclerosis in HIV-Infected Individuals: The Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM)
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DOI：
10.1159/000327606
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发表时间：
2011-01-01
影响因子：
4.2
通讯作者：
Shlipak, Michael
中科院分区：
文献类型：
--
作者：
Jotwani, Vasantha;Scherzer, Rebecca;Shlipak, Michael
背景/目的：在HIV感染者中，肾功能降低和蛋白尿与心血管疾病(CVD)和死亡率的高风险相关。我们调查了估计肾小球滤过率(EGFR)降低和蛋白尿是否与颈动脉内膜中层厚度(CIMT)评估的亚临床血管疾病有关。方法：对参加FRAM研究的476名无心血管疾病临床证据的HIV感染者进行横断面分析，采用多元线性回归分析。EGFR(Cys)和EGFR(Cr)由半胱氨酸氨基转移酶C和肌酐计算。白蛋白尿定义为阳性尿试纸条(<gt；=1+)或尿白蛋白/肌酐(<gt；=30 mg/g)。用高分辨率B超测量普通和内部CIMT。结果：在非校正分析中，EGFR(Cys)和EGFR(Cr)与常见和内部CIMT密切相关。EGFR(Cys)和EGFR(Cr)每下降10ml/min/1.73m(2)，分别增加0.008 mm的普通CIMT(p=0.003)和0.024 mm和0.029 mm的内部CIMT(p=0.003)。在根据年龄、性别和种族进行调整后，这些关联被消除了。在所有模型中，蛋白尿与常见的或内部的cIMT几乎没有关联。结论：根据CIMT评估，在无心血管病史的HIV感染者中，肾功能降低和蛋白尿与亚临床血管疾病无关。这些结果表明，研究应该集中在寻找肾脏疾病增加艾滋病毒感染者心血管风险的新机制上。版权所有(C)2011 S.Karger AG，巴塞尔
Background/Aims: 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 common and internal cIMT. Each 10 ml/min/1.73 m(2) 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. copyright (C) 2011 S. Karger AG, Basel