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乌干达北部古卢医院新诊断的HIV感染成人的肾功能损害及相关危险因素

Impaired renal function and associated risk factors in newly diagnosed HIV-infected adults in Gulu Hospital, Northern Uganda.

作者信息

Odongo Pancras, Wanyama Ronald, Obol James Henry, Apiyo Paska, Byakika-Kibwika Pauline

机构信息

Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.

Infectious Diseases Clinic, Gulu Regional Referral Hospital, P.O. Box 160, Gulu, Uganda.

出版信息

BMC Nephrol. 2015 Mar 31;16:43. doi: 10.1186/s12882-015-0035-3.

Abstract

BACKGROUND

Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. We aimed to determine the status of renal function and factors associated with impaired renal function in newly diagnosed HIV-infected adults in Northern Uganda.

METHODS

This was a seven month cross-sectional hospital-based study, involving newly diagnosed HIV-infected patients, 18 years and older. Patients with history of diabetes mellitus, hypertension and renal disease were excluded. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (Table one). Factors associated with impaired renal function (eGFR < 60 ml/min/1.73 m(2)) were thus sought.

RESULTS

We enrolled 361 participants (230, 63.7% female) with Mean ± standard deviation age of 31.4 ± 9.5 years. 52, (14.4%) had impaired renal function (eGFR <60 mL/min/1.73 m(2)) and of this 37 (71.2%) moderate renal impairment (eGFR 30-59.9 mL/min/1.73 m(2)) while 15 (28.8%) had severe renal impairment (eGFR <30 mL/min/1.73 m(2)). Proteinuria was recorded in 189 (52.4%) participants. Of these, 154 (81.5%) had mild (1+) while 8 (4.2%) had severe (3+) proteinuria. Using logistic regression, age, CD4 cell count, and proteinuria were significantly associated with impaired renal function; age >34 years (OR 2.8, 95% CI 1.3-5.9; P =0.009), CD4 count <350 cells/μL (OR 2.4, 95% CI 1.0-4.7; P =0.039) and proteinuria (OR 9.6, 95% CI 5.2-17.9; P < 0.001).

CONCLUSION

The prevalence of impaired renal function was high in new HIV-infected individuals in this region with limited resources. So, screening for renal disease in HIV is recommended at the time of HIV diagnosis.

摘要

背景

应在诊断人类免疫缺陷病毒(HIV)感染时进行肾脏疾病筛查。尽管乌干达北部HIV/AIDS的患病率很高,但在这个资源有限的地区,对于新诊断的HIV感染者的肾功能状况及其相关因素知之甚少。我们旨在确定乌干达北部新诊断的HIV感染成年人的肾功能状况以及与肾功能受损相关的因素。

方法

这是一项为期7个月的基于医院的横断面研究,纳入年龄在18岁及以上的新诊断HIV感染患者。排除有糖尿病、高血压和肾脏疾病史的患者。使用慢性肾脏病流行病学协作组(CKD-EPI)公式计算估计肾小球滤过率(eGFR)(表1)。由此寻找与肾功能受损(eGFR<60 ml/min/1.73 m²)相关的因素。

结果

我们纳入了361名参与者(230名,63.7%为女性),平均年龄±标准差为31.4±9.5岁。52名(14.4%)肾功能受损(eGFR<60 mL/min/1.73 m²),其中37名(71.2%)为中度肾功能损害(eGFR 30-59.9 mL/min/1.73 m²),15名(28.8%)为重度肾功能损害(eGFR<30 mL/min/1.73 m²)。189名(52.4%)参与者记录有蛋白尿。其中,154名(81.5%)为轻度(1+),8名(4.2%)为重度(3+)蛋白尿。使用逻辑回归分析,年龄、CD4细胞计数和蛋白尿与肾功能受损显著相关;年龄>34岁(比值比2.8,95%置信区间1.3-5.9;P =0.009),CD4计数<350个细胞/μL(比值比2.4,95%置信区间1.0-4.7;P =0.039)以及蛋白尿(比值比9.6,95%置信区间5.2-17.9;P<0.001)。

结论

在这个资源有限的地区,新感染HIV的个体中肾功能受损的患病率很高。因此,建议在HIV诊断时筛查肾脏疾病。

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