Mitchell McClean1, Petra Buzkova2, Matthew Budoff3, Michelle Estrella4, Matthew Freiberg5, Howard N Hodis6, Frank Palella7, Cecilia Shikuma8, Wendy S Post9, Samir Gupta1. 1. Division of Infectious Diseases, Indiana University School of Medicine Indianapolis, Indianapolis, IN. 2. Department of Biostatistics, University of Washington, Seattle, WA. 3. Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA. 4. University of California, San Francisco, CA and San Francisco VA Health Care System, San Francisco, CA. 5. Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Tennessee Valley Veterans Affairs Medical Center Geriatric Research Education and Clinical Centers (GRECC), Nashville, TN. 6. Division of Cardiovascular Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA. 7. Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL. 8. Department of Medicine, John A. Burns School of Medicine, University of Hawai'i at Mãnoa, Honolulu, HI; and. 9. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
INTRODUCTION: Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr). OBJECTIVES: The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score. METHODS: This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC. RESULTS: Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV-) had CIMT measurements and 366 (296 HIV+ and 70 HIV-) had CAC measurements available. In HIV- participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= -0.90, 95% CI: (-1.67 to -0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= -8.63, 95% CI: (-16.49 to -0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance. CONCLUSIONS: In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.
INTRODUCTION: Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr). OBJECTIVES: The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score. METHODS: This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC. RESULTS: Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV-) had CIMT measurements and 366 (296 HIV+ and 70 HIV-) had CAC measurements available. In HIV- participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= -0.90, 95% CI: (-1.67 to -0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= -8.63, 95% CI: (-16.49 to -0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance. CONCLUSIONS: In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.
Authors: Matthew J Budoff; John E Hokanson; Khurram Nasir; Leslee J Shaw; Gregory L Kinney; David Chow; Daniel Demoss; Vivek Nuguri; Vahid Nabavi; Raghu Ratakonda; Daniel S Berman; Paolo Raggi Journal: JACC Cardiovasc Imaging Date: 2010-12
Authors: Alexandra Mangili; Joseph F Polak; Lien A Quach; Jul Gerrior; Christine A Wanke Journal: Atherosclerosis Date: 2010-11-17 Impact factor: 5.162
Authors: Matthew J Budoff; Daniel J Rader; Muredach P Reilly; Emile R Mohler; Jim Lash; Wei Yang; Leigh Rosen; Melanie Glenn; Valerie Teal; Harold I Feldman Journal: Am J Kidney Dis Date: 2011-07-23 Impact factor: 8.860
Authors: Michelle C Odden; Rebecca Scherzer; Peter Bacchetti; Lynda Anne Szczech; Stephen Sidney; Carl Grunfeld; Michael G Shlipak Journal: Arch Intern Med Date: 2007-11-12
Authors: Carl Grunfeld; Joseph A C Delaney; Christine Wanke; Judith S Currier; Rebecca Scherzer; Mary L Biggs; Phyllis C Tien; Michael G Shlipak; Stephen Sidney; Joseph F Polak; Daniel O'Leary; Peter Bacchetti; Richard A Kronmal Journal: AIDS Date: 2009-09-10 Impact factor: 4.177
Authors: Maria da Conceição Brandão de Arruda Falcão; Josefina Cláudia Zírpoli; Valéria Maria de Albuquerque; Brivaldo Markman Filho; Nelson Antônio Moura de Araújo; Creso Abreu Falcão; Demócrito de Barros Miranda-Filho; Ricardo Alencar de Arraes Ximenes; Maria de Fátima Militão de Albuquerque; Heloísa Ramos Lacerda Journal: Arq Bras Cardiol Date: 2012-10-18 Impact factor: 2.000
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Andy I Choi; Yongmei Li; Steven G Deeks; Carl Grunfeld; Paul A Volberding; Michael G Shlipak Journal: Circulation Date: 2010-01-25 Impact factor: 29.690
Authors: G M Lucas; A Cozzi-Lepri; C M Wyatt; F A Post; A M Bormann; N F Crum-Cianflone; M J Ross Journal: HIV Med Date: 2013-09-11 Impact factor: 3.180
Authors: Malcolm West; Adrienne Kirby; Ralph A Stewart; Stefan Blankenberg; David Sullivan; Harvey D White; David Hunt; Ian Marschner; Edward Janus; Leonard Kritharides; Gerald F Watts; John Simes; Andrew M Tonkin Journal: J Am Heart Assoc Date: 2022-02-18 Impact factor: 5.501