University of California, San Francisco, Calif., USA.
Am J Nephrol. 2011;33(5):453-60. doi: 10.1159/000327606. Epub 2011 Apr 21.
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).
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.
In unadjusted analyses, eGFR(Cys) and eGFR(Cr) were strongly associated with com- mon and internal cIMT. Each 10 ml/min/1.73 m2 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.
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.
背景/目的：肾功能下降和白蛋白尿与 HIV 感染者发生心血管疾病（CVD）和死亡的风险增加相关。我们研究了估算肾小球滤过率（eGFR）降低和白蛋白尿是否与亚临床血管疾病相关，通过颈动脉内膜中层厚度（cIMT）评估。
使用多变量线性回归，对 FRAM 研究中 476 名无 CVD 临床证据的 HIV 感染者进行横断面分析。胱抑素 C 和肌酐水平计算 eGFR（Cys）和 eGFR（Cr）。白蛋白尿定义为尿试纸阳性（≥1+）或尿白蛋白/肌酐比值≥30mg/g。高分辨率 B 型超声测量普通和内部 cIMT。
在未校正分析中，eGFR（Cys）和 eGFR（Cr）与普通和内部 cIMT 密切相关。eGFR（Cys）和 eGFR（Cr）每降低 10ml/min/1.73m2，普通 cIMT 分别升高 0.008mm（p=0.003，p=0.01），内部 cIMT 分别升高 0.024mm 和 0.029mm（p=0.003）。这些关联在调整年龄、性别和种族后被消除。在所有模型中，白蛋白尿与普通或内部 cIMT 的相关性均较小。
在无既往 CVD 的 HIV 感染者中，亚临床血管疾病（通过 cIMT 评估）与肾功能下降和白蛋白尿无关。这些结果表明，研究应集中于寻找肾功能障碍使 HIV 感染者发生心血管风险的新机制。
