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The Association of Kidney Disease with Abnormal Cardiac Structure and Function among Ugandans with HIV Infection.

BACKGROUND
People with HIV (PWH) are at increased risk of both heart and kidney disease, but the relationship between kidney disease and cardiac structure and function in this population has not been well studied. In particular, whether the relationship between kidney disease and cardiac structure and function is stronger for PWH compared to uninfected controls is unknown.


METHODS
One hundred PWH on antiretroviral therapy were compared with one hundred age- and sex-matched controls without HIV in Uganda. Multivariable regression models were used to examine associations between creatinine and cystatin C based estimates of glomerular filtration rate (eGFR), albumin-creatinine ratio (ACR) and echocardiographic measures of cardiac structure and function.


RESULTS
PWH had lower eGFRcr (β -7.486, 95% CI -13.868 to -1.104, p=0.022) and higher rate of ACR ≥30 (OR 2.146, 95% CI 1.027 to 4.484, p=0.042) after adjustment for traditional risk factors. eGFR was inversely associated with both LV mass index (LVMI) and diastolic dysfunction in adjusted models, but not with systolic function. Albuminuria was associated with more diastolic dysfunction among PWH but not controls (p for interaction = 0.046). The association of HIV with higher LVMI (p=0.005) was not substantially affected by adjusting for eGFRcr.


CONCLUSION
Among Ugandans, eGFR is associated with elevated LV mass and diastolic dysfunction. The association between albuminuria and diastolic dysfunction is particularly strong for PWH.