Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease

Background: Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida. Methods: A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p<0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (<0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p<0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p<0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm 3 vs. 570 ± 342 cells/mm 3 , p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p<0.05). Conclusion: In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.

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Nontraditional Biomarkers for Cardiovascular Disease in Patients With Chronic Kidney Disease

Ramathibodi Medical Journal ◽

10.33165/rmj.2020.43.2.230208 ◽

2020 ◽

Vol 43 (2) ◽

pp. 51-60

Author(s):

Ittikorn Spanuchart ◽

Arkom Nongnuch ◽

Youg Liu

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Stiffness ◽

Mineral Metabolism ◽

Uremic Toxins ◽

Calcium Balance ◽

The Novel ◽

Cvd Risk ◽

Chd Risk

Cardiovascular disease (CVD) is the leading cause of death among patients who have chronic kidney disease (CKD). Nowadays, CKD per se is considered one of the coronary heart disease (CHD) risk equivalents. Apart from traditional CVD risk factors, there are several possible determinants for CVD in patients with CKD, for example, uremic toxins, increased inflammatory stage, abnormal bone mineral metabolism, and positive calcium balance. In this narrative review, we offer a summary of the extensively studied biomarkers for CVD in patients with CKD, including uremic toxins (p-cresol, indoxyl sulfate, and advanced glycated end products), and a novel indicator of arterial stiffness, cardio-ankle vascular index (CAVI), which is an independent prognostic predictor for CVD. For the uremic toxins, we reviewed their metabolisms, particularly, how the reduced renal function in CKD patients affect their clearance and their clearance with dialysis. Also, we pay attention to the recent evidence on how those uremic toxins contribute to CVD and their clinical associations. We do not include the possible treatment targeting at those uremic toxins. As for the novel indicator of arterial stiffness, we reviewed the clinical application of CAVI in comparison to the standard indicator for arterial stiffness, pulse wave velocity.

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Predictors of cardiovascular disease in patients with chronic kidney disease VD stage treated with hemodialysis

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.2.234513 ◽

2021 ◽

Vol 26 (2) ◽

pp. 59-66

Author(s):

I.M. Shifris ◽

I.O. Dudar ◽

Е.К. Krasiuk ◽

А.Yu. Shymova

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Primary Endpoint ◽

Heart Diseases ◽

Statistical Processing ◽

Venous Catheter ◽

Albumin Level ◽

Newly Diagnosed ◽

Cvd Risk

The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р<0.001) was stated, more than twice – of coronary artery disease (CAD; р<0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.

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Statins and Cardiovascular Disease Outcomes in Chronic Kidney Disease: Reaffirmation vs. Repudiation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122733 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2733 ◽

Cited By ~ 6

Author(s):

Chamberlain Obialo ◽

Elizabeth Ofili ◽

Keith Norris

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Risk Reduction ◽

Survival Advantage ◽

End Stage Kidney Disease ◽

Cvd Risk ◽

Disease Outcomes ◽

End Stage

Cardiovascular disease (CVD) burden is several-fold higher in patients with chronic kidney disease (CKD). Although statins have been shown to provide significant CVD benefits in both the general population and patients with CKD, this has not translated into survival advantage in patients with advanced CKD or on dialysis. It has been reported that CVD risk continues to escalate as CKD progresses to end-stage kidney disease (ESKD); however, the CVD risk reduction by statins appears to decline as patients’ progress from the early to later stages of CKD. Statins have also been associated with a higher incidence of stroke in ESKD patients. Thus, the CVD benefits of statins in ESKD remain questionable.

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Impact of Blood or Erythrocyte Membrane Fatty Acids for Disease Risk Prediction: Focusing on Cardiovascular Disease and Chronic Kidney Disease

Nutrients ◽

10.3390/nu10101454 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1454 ◽

Cited By ~ 6

Author(s):

Oh Kim ◽

Su Lee ◽

Won An

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Fatty Acids ◽

Kidney Disease ◽

Erythrocyte Membrane ◽

Risk Prediction ◽

Disease Risk ◽

Omega 3 ◽

Cvd Risk ◽

Coronary Syndrome

Fatty acids (FAs) are essential nutrients and main constituents of cell membranes that are involved in the signaling pathway and associated with health conditions. We investigated if blood or erythrocyte membrane FAs can predict the risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and related complications. Omega-3 (n-3) FAs are important predictors for metabolic syndrome, diabetes, CVD, and CKD risks, and the n-3 index is also a good biomarker for sudden cardiac death in coronary artery disease. Linoleic acid, which is one of the major n-6 FAs reflecting recent dietary FA intake, may predict CVD risk and mortality in the general population and patients with CKD. Monounsaturated FAs (MUFAs) are also related to diabetes or diabetic nephropathy. Oleic acid, a major MUFA, is an emerging marker that is related to acute coronary syndrome, low glomerular filtration rate, and vascular calcification in patients with CKD, and can be modified by n-3 FA supplementation. Saturated FAs, trans-FAs, and FA desaturation/elongation are associated with CVD risk; however, few studies have been conducted on patients with CKD. In summary, blood or erythrocyte membrane FA measurements are important for CVD and CKD risk prediction and management. Further studies are needed to elucidate the FAs for their risk predictions.

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Urinary Catalytic Iron in Obesity

Clinical Chemistry ◽

10.1373/clinchem.2010.154757 ◽

2011 ◽

Vol 57 (2) ◽

pp. 272-278 ◽

Cited By ~ 4

Author(s):

Tina K Thethi ◽

Kaushik Parsha ◽

Mohan Rajapurkar ◽

Banibrata Mukhopadhyay ◽

Sudhir Shah ◽

...

Keyword(s):

Cardiovascular Disease ◽

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Body Mass ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Waist To Hip Ratio ◽

Study Results ◽

Significant Difference

INTRODUCTION Obesity precedes the development of many cardiovascular disease risk factors, including type 2 diabetes mellitus (DM), hypertension, and chronic kidney disease. Catalytic iron, which has been associated with these chronic diseases, may be one of the links between obesity and these multifactorial diverse disorders. OBJECTIVE We investigated whether urinary catalytic iron is increased in obese individuals without DM and overt kidney disease. STUDY DESIGN We measured urinary catalytic iron using established methods in 200 randomly selected individuals without DM [100 who were obese (body mass index ≥30 kg/m2) and 100 who were nonobese (body mass index ≤27)]. Participants were selected from an outpatient clinic and community setting and were part of an ongoing cross-sectional study of obesity in individuals between the ages of 18 and 70 years. RESULTS There was a significant difference in mean (95% CI) urinary catalytic iron excretion between the obese participants and the nonobese participants, 463 (343–582) nmol/mg [52.3 (38.8–65.8) nmol/μmol] vs 197 (141–253) nmol/mg [22.3 (15.9–28.6) nmol/μmol]; P < 0.001. The significant predictors of increased urinary catalytic iron were obesity (P = 0.001) and waist-to-hip ratio (P = 0.03). CONCLUSIONS Our study results demonstrate that obesity and waist-to-hip ratio are associated with increased urinary catalytic iron, which may be a useful marker of oxidative stress. Additional studies are needed to determine the role of catalytic iron in increased cardiovascular disease and chronic kidney disease associated with obesity.

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Product of Serum Calcium and Phosphorus (Ca x Pi) as a Predictor of Cardiovascular Disease Risk in Patients with Chronic Kidney Disease

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v8i1.29829 ◽

2020 ◽

Vol 8 (1) ◽

pp. 23-26

Author(s):

Rojina Bakhunchhen ◽

Raju Kumar Dubey ◽

Archana Jayan ◽

Santosh Kumar Shah ◽

Prabin Khatri

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Calcium ◽

Cvd Risk ◽

Group 3 ◽

Calcium And Phosphorus ◽

Group 2 ◽

Group 1

INTRODUCTION: Most of the chronic kidney disease (CKD) patients develop cardiovascular disease (CVD) in their later stages. Various traditional CVD risk factors are highly prevalent in CKD but mortality of these patients cannot be fully justified by these CVD markers. So this study was designed to determine serum calcium and phosphorus product (Ca×Pi) to predict CVD risk in CKD patients. MATERIAL AND METHODS We followed the guidelines of NKF-KDOQI for CKD diagnosis and staging. Further the patients were classified into 3 different groups based on Ca×Pi product; <40 mg2/dl2 (group 1), 40-55 mg2/dl2 (group 2) and >55 mg2/dl2 (group 3). We then evaluated CVD risk by various traditional risk factors like age, BMI, BP, smoking history, dyslipidemia, previous history of CVD, LVH, arrhythmia, VHD, cardiomyopathy, and IHD. RESULTS: Higher level of Ca×Pi was associated with presence of LVH (32.30% in group 1, 31.42% in group 2 and 46.66% in group 3), Arrythemia (13.84% in group 1, 28.57% in group 2 and 46.67% in group 3), VHD (5.71% in group 2 and 10.00% in group 3), Cardiomyopathy (1.53% in group 1, 8.57% I group 2 and 6.66% in group 3), IHD (6.15% in group1, 11.42% in group 2 and 13.33% in group 3) and hypercholesterolemia, hypertriglyceridemia and increased LDLc. CONCLUSION: This study found that higher Ca×Pi increases with decline in glomerular filtration rate (GFR) and associated with CVD risks and CVD. So, this study raise a potential need to evaluate the level of calcium and phosphorus in all CKD patients and the level should be monitored more thoroughly to prevent CVD.

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Nomogram to predict risk of incident chronic kidney disease in high-risk population of cardiovascular disease in China: community-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-047774 ◽

2021 ◽

Vol 11 (11) ◽

pp. e047774

Author(s):

Qiuxia Zhang ◽

Jingyi Zhang ◽

Li Lei ◽

Hongbin Liang ◽

Yun Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cox Regression ◽

Validation Cohort ◽

High Risk Population ◽

Cvd Risk ◽

Incident Chronic Kidney Disease

AimsTo develop a nomogram for incident chronic kidney disease (CKD) risk evaluation among community residents with high cardiovascular disease (CVD) risk.MethodsIn this retrospective cohort study, 5730 non-CKD residents with high CVD risk participating the National Basic Public Health Service between January 2015 and December 2020 in Guangzhou were included. Endpoint was incident CKD defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 during the follow-up period. The entire cohorts were randomly (2:1) assigned to a development cohort and a validation cohort. Predictors of incident CKD were selected by multivariable Cox regression and stepwise approach. A nomogram based on these predictors was developed and evaluated with concordance index (C-index) and area under curve (AUC).ResultsDuring the median follow-up period of 4.22 years, the incidence of CKD was 19.09% (n=1094) in the entire cohort, 19.03% (727 patients) in the development cohort and 19.21% (367 patients) in the validation cohort. Age, body mass index, eGFR 60–89 mL/min/1.73 m2, diabetes and hypertension were selected as predictors. The nomogram demonstrated a good discriminative power with C-index of 0.778 and 0.785 in the development and validation cohort. The 3-year, 4-year and 5-year AUCs were 0.817, 0.814 and 0.834 in the development cohort, and 0.830, 0.847 and 0.839 in the validation cohort.ConclusionOur nomogram based on five readily available predictors is a reliable tool to identify high-CVD risk patients at risk of incident CKD. This prediction model may help improving the healthcare strategies in primary care.

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Tryptophan levels associate with incident cardiovascular disease in chronic kidney disease

Clinical Kidney Journal ◽

10.1093/ckj/sfaa031 ◽

2020 ◽

Cited By ~ 4

Author(s):

Vetalise C Konje ◽

Thekkelnaycke M Rajendiran ◽

Keith Bellovich ◽

Crystal A Gadegbeku ◽

Debbie S Gipson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Receiver Operating Curve ◽

Cvd Risk ◽

Diabetes Status ◽

Ckd Stage ◽

History Of

Abstract Background Non-traditional risk factors like inflammation and oxidative stress play an essential role in the increased cardiovascular disease (CVD) risk prevalent in chronic kidney disease (CKD). Tryptophan catabolism by the kynurenine pathway (KP) is linked to systemic inflammation and CVD in the general and dialysis population. However, the relationship of KP to incident CVD in the CKD population is unknown. Methods We measured tryptophan metabolites using targeted mass spectrometry in 92 patients with a history of CVD (old CVD); 46 patients with no history of CVD and new CVD during follow-up (no CVD); and 46 patients with no CVD history who developed CVD in the median follow-up period of 2 years (incident CVD). Results The three groups are well-matched in age, gender, race, diabetes status and CKD stage, and only differed in total cholesterol and proteinuria. Tryptophan and kynurenine levels significantly decreased in patients with ‘Incident CVD’ compared with the no CVD or old CVD groups (P = 5.2E–7; P = 0.003 respectively). Kynurenic acid, 3-hydroxykynurenine and kynurenine are all increased with worsening CKD stage (P < 0.05). An increase in tryptophan levels at baseline was associated with 0.32-fold lower odds of incident CVD (P = 0.000014) compared with the no CVD group even after adjustment for classic CVD risk factors. Addition of tryptophan and kynurenine levels to the receiver operating curve constructed from discriminant analysis predicting incident CVD using baseline clinical variables increased the area under the curve from 0.76 to 0.82 (P = 0.04). Conclusions In summary, our study demonstrates that low tryptophan levels are associated with incident CVD in CKD.

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Prevalence of atheromatous and non-atheromatous cardiovascular disease by age in chronic kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy277 ◽

2018 ◽

Vol 35 (5) ◽

pp. 827-836 ◽

Cited By ~ 6

Author(s):

Cédric Villain ◽

Marie Metzger ◽

Christian Combe ◽

Denis Fouque ◽

Luc Frimat ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Estimated Glomerular Filtration Rate ◽

Age Groups ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Disease Epidemiology ◽

Artery Disease

Abstract Background Although chronic kidney disease (CKD) and age are major risk factors for cardiovascular disease (CVD), little is known about the relative proportions of atheromatous and non-atheromatous CVD by age in CKD patients. Methods We used baseline data from the French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort of 3033 patients (65% men) with CKD Stages 3–4 to study crude and adjusted associations between age, the estimated glomerular filtration rate (eGFR), atheromatous CVD (coronary artery disease, peripheral artery disease and stroke) and non-atheromatous CVD (heart failure, cardiac arrhythmia and valvular heart disease). Results Mean age was 66.8 and mean Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR was 32.9 mL/min/1.73 m2. In the <65, (65–74), (75–84) and ≥85 year age groups, the prevalence was, respectively, 18.7, 35.5, 42.9 and 37.8% for atheromatous CVD, and 14.9, 28.4, 38.1 and 56.4% for non-atheromatous CVD. After adjusting for albuminuria, sex and CVD risk factors, the odds ratio (OR) [95% confidence interval (CI)] for (65–74), (75–84) and ≥85 age groups (compared with the <65 group) was, respectively, 1.99 (1.61–2.46), 2.89 (2.30–3.62), 2.72 (1.77–4.18) for atheromatous CVD and 2.07 (1.66–2.58), 3.15 (2.50–3.97), 7.04 (4.67–10.61) for non-atheromatous CVD. Compared with patients with an eGFR ≥30 mL/min/1.73 m2, those with an eGFR <30 mL/min/1.73 m2 had a higher OR for atheromatous CVD [1.21 (1.01–1.44)] and non-atheromatous CVD [1.16 (0.97–1.38)]. Conclusions In this large cohort of CKD patients, both atheromatous and non-atheromatous CVD were highly prevalent and more frequent in older patients. In a given age group, the prevalence of atheromatous and non-atheromatous CVD was similar (except for a greater prevalence of non-atheromatous CVD after 85).

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