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Elevated Albuminuria Tied to ASCVD Risk in Older People With HIV
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10th International Workshop on HIV and Aging, October 10-11, 2019, New York
Mark Mascolini
Cross-sectional analysis of 164 older people with HIV correlated moderate to severely elevated albuminuria to atherosclerotic cardiovascular disease (ASCVD) risk, which was high in this New York City cohort [1]. The finding suggests kidney and heart disease may share pathophysiologic pathways. Almost half of participants with a high ASCVD score were not taking statins.
Weill Cornell Medical Center researchers who conducted this study noted that kidney and cardiovascular disease account for much of the morbidity and mortality seen in aging people with HIV infection. To get a better understanding of how the conditions may be related, they measured albuminuria and estimated glomerular filtration rate (eGFR), two kidney disease markers, as well as ASCVD risk score, in an older group of people with HIV.
This cross-sectional analysis involved people completing the Research on Older Adults With HIV 2.0 Survey. The investigators invited participants over age 55 to enroll in a substudy involving additional lab testing and age-related assessments, including a detailed questionnaire on health status, quality of life, and psychosocial factors.
The 164 people who participated in this analysis had a median age of 60 (interquartile range 57 to 64), and one third were female. The group had been diagnosed with HIV for a median 25 years, 93% had a viral load below 200 copies, and median CD4 count stood at 582.
Median eGFR measured 75 mL/min. Five people (3%) had chronic kidney disease (CKD) classification G5, 3 (2%) G4, 33 (20%) G3, 79 (48%) G2, and 43 (26%) G1. (The higher the G number, the worse the kidney function [2]). Albumin measures indicated that 28 people (17%) had moderately elevated albuminuria (30-300 mg albumin/g urine creatinine, or microalbuminuria), while 8 (5%) had severely elevated albuminuria (above 300 mg albumin/g urine creatinine, or macroalbuminuria).
Albuminuria correlated inversely with eGFR (r = -0.19, P = 0.021) but did not correlate significantly with age (r = 0.13, P = 0.11). Moderate to severely elevated albuminuria was not associated with use of tenofovir disoproxil fumarate (P = 0.32) or tenofovir alafenamide (P = 0.26). Nor did moderate to severely elevated albuminuria correlate with use of ACE or ARB medications (angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers).
Median ASCVD score stood at 10.4%, indicating a high 10-year risk of heart disease or stroke. And ASCVD score correlated positively with albuminuria (r = 0.25, P = 0.005). Further analysis indicated a significant relationship between current diabetes and moderate to severe albuminuria elevation (P = 0.019). Among participants with an ASCVD score above 7.5%, only half (52%) were taking a statin. Almost 1 in 5 participants with an ASCVD above 7.5%, 19%, were taking abacavir, although some research links abacavir to higher risk of cardiac events.
The Weill Cornell team rated the 10-year ASCVD-based cardiovascular risk "remarkably elevated." The correlation between elevated cardiac risk and elevated albuminuria suggested "common metabolic and inflammatory pathophysiologic mechanisms" of cardiovascular and kidney disease. Low statin use and continued abacavir in people with a high ASCVD score buttressed their sense that "there is room to optimize cardiovascular disease prevention in older persons living with HIV."
References
1. Johnston C, Ifeagwu K, Siegler E, et al. Elevated cardiac risk score by ASCVD calculation is associated with albuminuria in older people living with HIV. 10th International Workshop on HIV and Aging, October 10-11, 2019, New York. Abstract 6.
2. The Renal Association. CKD stages.
https://renal.org/information-resources/the-uk-eckd-guide/ckd-stages/
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