Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study. PLoS Medicine
The D:A:D study has developed specific models to predict the risk for CVD and CKD events in HIV-positive people. Boyd et al. on behalf of the D:A:D study aimed to study whether participants in D:A:D at high (>5%) predicted risk for both cardiovascular disease (CVD) and chronic kidney disease (CKD) would be at even greater risk for CVD and CKD events.
CKD was defined as confirmed estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2. The authors calculated the CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%±5%, >5%). A total of 27,215 participants contributed 202,034 person-years of follow-up. Participants at high CVD risk had a 5.63-fold (p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (p = 0.005) increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction.
In conclusion, the study found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD compared with those at low predicted risk for both, and those at high predicted risk for only CVD or only CKD. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results should further encourage clinicians to prioritize addressing modifiable risks for CVD and CKD in HIV-positive people.