Association of urine biomarkers of kidney health with subclinical cardiovascular disease in a MACS substudy.

OBJECTIVE: To determine whether urine biomarkers of kidney health are associated with subclinical cardiovascular disease among men living with and without HIV.

DESIGN: Cross-sectional study within the Multicenter AIDS Cohort Study (MACS) among 504 men with and without HIV infection who underwent cardiac computed tomography scans and had urine biomarkers measured within the preceding two years.

METHODS: Our primary predictors were four urine biomarkers of endothelial (albuminuria), proximal tubule dysfunction (alpha-1-microglobulin [A1 M] and injury (kidney injury molecule-1 [KIM-1]) and tubulointerstitial fibrosis (pro-collagen-III N-terminal peptide [PIIINP]). These were evaluated for association with coronary artery calcium (CAC) prevalence, CAC extent, total plaque score, and total segment stenosis using multivariable regression.

RESULTS: Of the 504 participants, 384 were men with HIV (MWH) and 120 were men without HIV. In models adjusted for sociodemographic factors, cardiovascular disease risk factors, eGFR, and HIV-related factors, each two-fold higher concentration of albuminuria was associated with a greater extent of CAC (1.35-fold higher, 95% CI [1.11, 1.65]), and segment stenosis (1.08-fold greater, 95% CI [1.01, 1.16]). Associations were similar between MWH and men without HIV in stratified analyses. The third quartile of A1 M showed an association with greater CAC extent, total plaque score, and total segment stenosis, compared with the lowest quartile.

CONCLUSIONS: Worse endothelial and proximal tubule dysfunction as reflected by higher urine albumin and A1 M, were associated with greater CAC extent and coronary artery stenosis.