Department of Medicine, San Francisco Veterans Affairs Medical Center, and University of California, San Francisco, USA.
Circulation. 2010 Feb 9;121(5):651-8. doi: 10.1161/CIRCULATIONAHA.109.898585. Epub 2010 Jan 25.
Cardiovascular disease (CVD) is now a leading cause of death in HIV-infected persons; however, risk markers for CVD are ill defined in this population. We examined the association between longitudinal measures of kidney function and albuminuria with risk of atherosclerotic CVD and heart failure in a contemporary cohort of HIV-infected individuals.
We followed a national sample of 17 264 HIV-infected persons receiving care in the Veterans Health Administration for (1) incident CVD, defined as coronary, cerebrovascular, or peripheral arterial disease, and (2) incident heart failure. Rates of CVD and heart failure were at least 6-fold greater in the highest-risk patients with an estimated glomerular filtration rate (eGFR) <30 mL/min per 1.73 m(2) and albuminuria > or =300 mg/dL versus those with no evidence of kidney disease (eGFR > or =60 mL/min per 1.73 m(2) and no albuminuria). After multivariable adjustment, eGFR levels 45 to 59, 30 to 44, and <30 mL/min per 1.73 m(2) were associated with hazard ratios for incident CVD of 1.46 (95% confidence interval, 1.15 to 1.86), 2.03 (1.47 to 2.82), and 1.99 (1.46 to 2.70) compared with eGFR > or =60 mL/min per 1.73 m(2). Similarly, albuminuria levels 30, 100, and > or =300 mg/dL had hazard ratios for CVD of 1.28 (1.09 to 1.51), 1.48 (1.15 to 1.90), and 1.71 (1.30 to 2.27) compared with absent albuminuria. The associations between eGFR and albuminuria with heart failure were larger in magnitude and followed the same trends.
In this national sample of HIV-infected persons, eGFR and albuminuria levels were strongly associated with risk of CVD and heart failure. Kidney function and albuminuria provide complementary prognostic information that may aid CVD risk stratification in HIV-infected persons.
心血管疾病（CVD）现在是感染艾滋病毒人群的主要死因；然而，该人群中 CVD 的风险标志物仍未明确。我们在一个当代艾滋病毒感染者的队列中研究了纵向肾功能和白蛋白尿与动脉粥样硬化性 CVD 和心力衰竭风险之间的关系。
我们对在退伍军人健康管理局接受治疗的 17264 名艾滋病毒感染者进行了全国性样本的随访，以观察（1）CVD 的发生率，定义为冠心病、脑血管病或外周动脉疾病，以及（2）心力衰竭的发生率。在估计肾小球滤过率（eGFR）<30 mL/min/1.73 m2 且白蛋白尿>或=300 mg/dL 的最高风险患者中，CVD 和心力衰竭的发生率至少是无肾脏疾病（eGFR >或=60 mL/min/1.73 m2 且无白蛋白尿）患者的 6 倍。在多变量调整后，eGFR 水平为 45 至 59、30 至 44 和<30 mL/min/1.73 m2 与 CVD 发生率的风险比分别为 1.46（95%置信区间，1.15 至 1.86）、2.03（1.47 至 2.82）和 1.99（1.46 至 2.70）与 eGFR >或=60 mL/min/1.73 m2。同样，白蛋白尿水平为 30、100 和>或=300 mg/dL 的患者发生 CVD 的风险比分别为 1.28（1.09 至 1.51）、1.48（1.15 至 1.90）和 1.71（1.30 至 2.27）与无白蛋白尿。eGFR 和白蛋白尿与心力衰竭之间的相关性在幅度上更大，且呈现相同的趋势。
在这个国家艾滋病毒感染者样本中，eGFR 和白蛋白尿水平与 CVD 和心力衰竭风险密切相关。肾功能和白蛋白尿提供了互补的预后信息，可能有助于对艾滋病毒感染者进行 CVD 风险分层。
