Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

Lene Ryom, Jens D. Lundgren, Michael J. Ross, Ole Kirk, Matthew Law, Philippe Morlat, Eric Fontas, Colette Smit, Christoph A. Fux, Camilla I. Hatleberg, Stphane De Wit, Caroline A. Sabin, Amanda Mocroft, W. El-Sadr, G. Calvo, F. Dabis, O. Kirk, M. Law, A. D.Arminio Monforte, L. MorfeldtC. Pradier, P. Reiss, R. Weber, S. De Wit, B. Powderly, N. Shortman, C. Moecklinghoff, G. Reilly, X. Franquet, C. I. Hatleberg, L. Ryom, C. A. Sabin, D. Kamara, Cj Smith, A. Phillips, A. Mocroft, A. Bojesen, A. L. Grevsen, C. Matthews, D. Raben, J. D. Lundgren, A. Lind-Thomsen, R. Salbøl Brandt, M. Hillebreght, S. Zaheri, F. W.N.M. Wit, F. Schöni-Affolter, A. Travelli, I. Fanti, O. Leleux, E. Thulin, A. Sundström, G. Bartsch, G. Thompsen, M. Delforge, E. Fontas, C. Caissotti, K. Dollet, S. Mateu, F. Torres, R. Puhr, D. Kristensen, A. Sjøl, P. Meidahl, J. Helweg-Larsen, J. Schmidt Iversen, L. Ryom, A. Mocroft, O. Kirk, P. Reiss, C. Smit, M. Ross, C. A. Fux, P. Morlat, E. Fontas, D. A. Kamara, C. J. Smith, J. D. Lundgren, C. J. Smith, L. Ryom, C. I. Hatleberg, A. Phillips, R. Weber, P. Morlat, C. Pradier, P. Reiss, F. W.N.M. Wit, N. Friis-Møller, J. Kowalska, J. D. Lundgren, C. Sabin, M. Law, A. Darminio Monforte, F. Dabis, F. Bonnet, P. Reiss, F. W.N.M. Wit, C. Smith, D. A. Kamara, J. Bohlius, M. Bower, G. Fätkenheuer, A. Grulich, L. Ryom, C. I. Hatleberg, J. D. Lundgren

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background. 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. Methods. 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. Results. 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 m2 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 m2. 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 m2 remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m2 (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]). Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)1212-1220
Number of pages9
JournalJournal of Infectious Diseases
Volume214
Issue number8
DOIs
StatePublished - Oct 15 2016
Externally publishedYes

Fingerprint

Cardiovascular Diseases
HIV
Kidney
Glomerular Filtration Rate
Confidence Intervals
Myocardial Infarction
Sudden Cardiac Death
Incidence
Population

Keywords

  • Cardiovascular disease
  • EGFR
  • HIV
  • Invasive cardiovascular procedures
  • Kidney disease
  • Myocardial infarction
  • Renal impairment
  • Stroke
  • Sudden cardiac death

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

Cite this

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals : The D:A:D Study. / Ryom, Lene; Lundgren, Jens D.; Ross, Michael J.; Kirk, Ole; Law, Matthew; Morlat, Philippe; Fontas, Eric; Smit, Colette; Fux, Christoph A.; Hatleberg, Camilla I.; De Wit, Stphane; Sabin, Caroline A.; Mocroft, Amanda; El-Sadr, W.; Calvo, G.; Dabis, F.; Kirk, O.; Law, M.; Monforte, A. D.Arminio; Morfeldt, L.; Pradier, C.; Reiss, P.; Weber, R.; De Wit, S.; Powderly, B.; Shortman, N.; Moecklinghoff, C.; Reilly, G.; Franquet, X.; Hatleberg, C. I.; Ryom, L.; Sabin, C. A.; Kamara, D.; Smith, Cj; Phillips, A.; Mocroft, A.; Bojesen, A.; Grevsen, A. L.; Matthews, C.; Raben, D.; Lundgren, J. D.; Lind-Thomsen, A.; Brandt, R. Salbøl; Hillebreght, M.; Zaheri, S.; Wit, F. W.N.M.; Schöni-Affolter, F.; Travelli, A.; Fanti, I.; Leleux, O.; Thulin, E.; Sundström, A.; Bartsch, G.; Thompsen, G.; Delforge, M.; Fontas, E.; Caissotti, C.; Dollet, K.; Mateu, S.; Torres, F.; Puhr, R.; Kristensen, D.; Sjøl, A.; Meidahl, P.; Helweg-Larsen, J.; Iversen, J. Schmidt; Ryom, L.; Mocroft, A.; Kirk, O.; Reiss, P.; Smit, C.; Ross, M.; Fux, C. A.; Morlat, P.; Fontas, E.; Kamara, D. A.; Smith, C. J.; Lundgren, J. D.; Smith, C. J.; Ryom, L.; Hatleberg, C. I.; Phillips, A.; Weber, R.; Morlat, P.; Pradier, C.; Reiss, P.; Wit, F. W.N.M.; Friis-Møller, N.; Kowalska, J.; Lundgren, J. D.; Sabin, C.; Law, M.; Monforte, A. Darminio; Dabis, F.; Bonnet, F.; Reiss, P.; Wit, F. W.N.M.; Smith, C.; Kamara, D. A.; Bohlius, J.; Bower, M.; Fätkenheuer, G.; Grulich, A.; Ryom, L.; Hatleberg, C. I.; Lundgren, J. D.

In: Journal of Infectious Diseases, Vol. 214, No. 8, 15.10.2016, p. 1212-1220.

Research output: Contribution to journalArticle

Ryom, L, Lundgren, JD, Ross, MJ, Kirk, O, Law, M, Morlat, P, Fontas, E, Smit, C, Fux, CA, Hatleberg, CI, De Wit, S, Sabin, CA, Mocroft, A, El-Sadr, W, Calvo, G, Dabis, F, Kirk, O, Law, M, Monforte, ADA, Morfeldt, L, Pradier, C, Reiss, P, Weber, R, De Wit, S, Powderly, B, Shortman, N, Moecklinghoff, C, Reilly, G, Franquet, X, Hatleberg, CI, Ryom, L, Sabin, CA, Kamara, D, Smith, C, Phillips, A, Mocroft, A, Bojesen, A, Grevsen, AL, Matthews, C, Raben, D, Lundgren, JD, Lind-Thomsen, A, Brandt, RS, Hillebreght, M, Zaheri, S, Wit, FWNM, Schöni-Affolter, F, Travelli, A, Fanti, I, Leleux, O, Thulin, E, Sundström, A, Bartsch, G, Thompsen, G, Delforge, M, Fontas, E, Caissotti, C, Dollet, K, Mateu, S, Torres, F, Puhr, R, Kristensen, D, Sjøl, A, Meidahl, P, Helweg-Larsen, J, Iversen, JS, Ryom, L, Mocroft, A, Kirk, O, Reiss, P, Smit, C, Ross, M, Fux, CA, Morlat, P, Fontas, E, Kamara, DA, Smith, CJ, Lundgren, JD, Smith, CJ, Ryom, L, Hatleberg, CI, Phillips, A, Weber, R, Morlat, P, Pradier, C, Reiss, P, Wit, FWNM, Friis-Møller, N, Kowalska, J, Lundgren, JD, Sabin, C, Law, M, Monforte, AD, Dabis, F, Bonnet, F, Reiss, P, Wit, FWNM, Smith, C, Kamara, DA, Bohlius, J, Bower, M, Fätkenheuer, G, Grulich, A, Ryom, L, Hatleberg, CI & Lundgren, JD 2016, 'Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study', Journal of Infectious Diseases, vol. 214, no. 8, pp. 1212-1220. https://doi.org/10.1093/infdis/jiw342
Ryom, Lene ; Lundgren, Jens D. ; Ross, Michael J. ; Kirk, Ole ; Law, Matthew ; Morlat, Philippe ; Fontas, Eric ; Smit, Colette ; Fux, Christoph A. ; Hatleberg, Camilla I. ; De Wit, Stphane ; Sabin, Caroline A. ; Mocroft, Amanda ; El-Sadr, W. ; Calvo, G. ; Dabis, F. ; Kirk, O. ; Law, M. ; Monforte, A. D.Arminio ; Morfeldt, L. ; Pradier, C. ; Reiss, P. ; Weber, R. ; De Wit, S. ; Powderly, B. ; Shortman, N. ; Moecklinghoff, C. ; Reilly, G. ; Franquet, X. ; Hatleberg, C. I. ; Ryom, L. ; Sabin, C. A. ; Kamara, D. ; Smith, Cj ; Phillips, A. ; Mocroft, A. ; Bojesen, A. ; Grevsen, A. L. ; Matthews, C. ; Raben, D. ; Lundgren, J. D. ; Lind-Thomsen, A. ; Brandt, R. Salbøl ; Hillebreght, M. ; Zaheri, S. ; Wit, F. W.N.M. ; Schöni-Affolter, F. ; Travelli, A. ; Fanti, I. ; Leleux, O. ; Thulin, E. ; Sundström, A. ; Bartsch, G. ; Thompsen, G. ; Delforge, M. ; Fontas, E. ; Caissotti, C. ; Dollet, K. ; Mateu, S. ; Torres, F. ; Puhr, R. ; Kristensen, D. ; Sjøl, A. ; Meidahl, P. ; Helweg-Larsen, J. ; Iversen, J. Schmidt ; Ryom, L. ; Mocroft, A. ; Kirk, O. ; Reiss, P. ; Smit, C. ; Ross, M. ; Fux, C. A. ; Morlat, P. ; Fontas, E. ; Kamara, D. A. ; Smith, C. J. ; Lundgren, J. D. ; Smith, C. J. ; Ryom, L. ; Hatleberg, C. I. ; Phillips, A. ; Weber, R. ; Morlat, P. ; Pradier, C. ; Reiss, P. ; Wit, F. W.N.M. ; Friis-Møller, N. ; Kowalska, J. ; Lundgren, J. D. ; Sabin, C. ; Law, M. ; Monforte, A. Darminio ; Dabis, F. ; Bonnet, F. ; Reiss, P. ; Wit, F. W.N.M. ; Smith, C. ; Kamara, D. A. ; Bohlius, J. ; Bower, M. ; Fätkenheuer, G. ; Grulich, A. ; Ryom, L. ; Hatleberg, C. I. ; Lundgren, J. D. / Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals : The D:A:D Study. In: Journal of Infectious Diseases. 2016 ; Vol. 214, No. 8. pp. 1212-1220.
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title = "Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study",
abstract = "Background. 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. Methods. 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. Results. 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 m2 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 m2. 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 m2 remained associated with 30{\%}-40{\%} increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m2 (incidence rate ratio, 3.08 [95{\%} CI, 2.04-4.65]). Conclusions. 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.",
keywords = "Cardiovascular disease, EGFR, HIV, Invasive cardiovascular procedures, Kidney disease, Myocardial infarction, Renal impairment, Stroke, Sudden cardiac death",
author = "Lene Ryom and Lundgren, {Jens D.} and Ross, {Michael J.} and Ole Kirk and Matthew Law and Philippe Morlat and Eric Fontas and Colette Smit and Fux, {Christoph A.} and Hatleberg, {Camilla I.} and {De Wit}, Stphane and Sabin, {Caroline A.} and Amanda Mocroft and W. El-Sadr and G. Calvo and F. Dabis and O. Kirk and M. Law and Monforte, {A. D.Arminio} and L. Morfeldt and C. Pradier and P. Reiss and R. Weber and {De Wit}, S. and B. Powderly and N. Shortman and C. Moecklinghoff and G. Reilly and X. Franquet and Hatleberg, {C. I.} and L. Ryom and Sabin, {C. A.} and D. Kamara and Cj Smith and A. Phillips and A. Mocroft and A. Bojesen and Grevsen, {A. L.} and C. Matthews and D. Raben and Lundgren, {J. D.} and A. Lind-Thomsen and Brandt, {R. Salb{\o}l} and M. Hillebreght and S. Zaheri and Wit, {F. W.N.M.} and F. Sch{\"o}ni-Affolter and A. Travelli and I. Fanti and O. Leleux and E. Thulin and A. Sundstr{\"o}m and G. Bartsch and G. Thompsen and M. Delforge and E. Fontas and C. Caissotti and K. Dollet and S. Mateu and F. Torres and R. Puhr and D. Kristensen and A. Sj{\o}l and P. Meidahl and J. Helweg-Larsen and Iversen, {J. Schmidt} and L. Ryom and A. Mocroft and O. Kirk and P. Reiss and C. Smit and M. Ross and Fux, {C. A.} and P. Morlat and E. Fontas and Kamara, {D. A.} and Smith, {C. J.} and Lundgren, {J. D.} and Smith, {C. J.} and L. Ryom and Hatleberg, {C. I.} and A. Phillips and R. Weber and P. Morlat and C. Pradier and P. Reiss and Wit, {F. W.N.M.} and N. Friis-M{\o}ller and J. Kowalska and Lundgren, {J. D.} and C. Sabin and M. Law and Monforte, {A. Darminio} and F. Dabis and F. Bonnet and P. Reiss and Wit, {F. W.N.M.} and C. Smith and Kamara, {D. A.} and J. Bohlius and M. Bower and G. F{\"a}tkenheuer and A. Grulich and L. Ryom and Hatleberg, {C. I.} and Lundgren, {J. D.}",
year = "2016",
month = "10",
day = "15",
doi = "10.1093/infdis/jiw342",
language = "English (US)",
volume = "214",
pages = "1212--1220",
journal = "Journal of Infectious Diseases",
issn = "0022-1899",
publisher = "Oxford University Press",
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TY - JOUR

T1 - Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals

T2 - The D:A:D Study

AU - Ryom, Lene

AU - Lundgren, Jens D.

AU - Ross, Michael J.

AU - Kirk, Ole

AU - Law, Matthew

AU - Morlat, Philippe

AU - Fontas, Eric

AU - Smit, Colette

AU - Fux, Christoph A.

AU - Hatleberg, Camilla I.

AU - De Wit, Stphane

AU - Sabin, Caroline A.

AU - Mocroft, Amanda

AU - El-Sadr, W.

AU - Calvo, G.

AU - Dabis, F.

AU - Kirk, O.

AU - Law, M.

AU - Monforte, A. D.Arminio

AU - Morfeldt, L.

AU - Pradier, C.

AU - Reiss, P.

AU - Weber, R.

AU - De Wit, S.

AU - Powderly, B.

AU - Shortman, N.

AU - Moecklinghoff, C.

AU - Reilly, G.

AU - Franquet, X.

AU - Hatleberg, C. I.

AU - Ryom, L.

AU - Sabin, C. A.

AU - Kamara, D.

AU - Smith, Cj

AU - Phillips, A.

AU - Mocroft, A.

AU - Bojesen, A.

AU - Grevsen, A. L.

AU - Matthews, C.

AU - Raben, D.

AU - Lundgren, J. D.

AU - Lind-Thomsen, A.

AU - Brandt, R. Salbøl

AU - Hillebreght, M.

AU - Zaheri, S.

AU - Wit, F. W.N.M.

AU - Schöni-Affolter, F.

AU - Travelli, A.

AU - Fanti, I.

AU - Leleux, O.

AU - Thulin, E.

AU - Sundström, A.

AU - Bartsch, G.

AU - Thompsen, G.

AU - Delforge, M.

AU - Fontas, E.

AU - Caissotti, C.

AU - Dollet, K.

AU - Mateu, S.

AU - Torres, F.

AU - Puhr, R.

AU - Kristensen, D.

AU - Sjøl, A.

AU - Meidahl, P.

AU - Helweg-Larsen, J.

AU - Iversen, J. Schmidt

AU - Ryom, L.

AU - Mocroft, A.

AU - Kirk, O.

AU - Reiss, P.

AU - Smit, C.

AU - Ross, M.

AU - Fux, C. A.

AU - Morlat, P.

AU - Fontas, E.

AU - Kamara, D. A.

AU - Smith, C. J.

AU - Lundgren, J. D.

AU - Smith, C. J.

AU - Ryom, L.

AU - Hatleberg, C. I.

AU - Phillips, A.

AU - Weber, R.

AU - Morlat, P.

AU - Pradier, C.

AU - Reiss, P.

AU - Wit, F. W.N.M.

AU - Friis-Møller, N.

AU - Kowalska, J.

AU - Lundgren, J. D.

AU - Sabin, C.

AU - Law, M.

AU - Monforte, A. Darminio

AU - Dabis, F.

AU - Bonnet, F.

AU - Reiss, P.

AU - Wit, F. W.N.M.

AU - Smith, C.

AU - Kamara, D. A.

AU - Bohlius, J.

AU - Bower, M.

AU - Fätkenheuer, G.

AU - Grulich, A.

AU - Ryom, L.

AU - Hatleberg, C. I.

AU - Lundgren, J. D.

PY - 2016/10/15

Y1 - 2016/10/15

N2 - Background. 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. Methods. 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. Results. 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 m2 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 m2. 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 m2 remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m2 (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]). Conclusions. 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.

AB - Background. 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. Methods. 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. Results. 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 m2 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 m2. 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 m2 remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m2 (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]). Conclusions. 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.

KW - Cardiovascular disease

KW - EGFR

KW - HIV

KW - Invasive cardiovascular procedures

KW - Kidney disease

KW - Myocardial infarction

KW - Renal impairment

KW - Stroke

KW - Sudden cardiac death

UR - http://www.scopus.com/inward/record.url?scp=84990923829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990923829&partnerID=8YFLogxK

U2 - 10.1093/infdis/jiw342

DO - 10.1093/infdis/jiw342

M3 - Article

C2 - 27485357

AN - SCOPUS:84990923829

VL - 214

SP - 1212

EP - 1220

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 8

ER -