Ekrikpo Udeme E, Kengne Andre P, Akpan Effiong E, Effa Emmanuel E, Bello Aminu K, Ekott John U, George Cindy, Salako Babatunde L, Okpechi Ikechi G
Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa Department of Medicine, University of Uyo, Uyo, Nigeria Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa Department of Medicine, University of Calabar, Calabar, Nigeria Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
Medicine (Baltimore). 2018 Apr;97(16):e0380. doi: 10.1097/MD.0000000000010380.
Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria.This is a single center, 15-year analysis in ART-naïve patients. CKD was defined as the occurrence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m on 2 consecutive occasions 3 to 12 months apart using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The Cochran-Armitage and Cuzick tests were employed to assess for trend across the years for CKD prevalence and CD4 count, respectively. Multivariable logistic regression models were used to identify independent associations with CKD.In all, 1317 patients (62.2% females) with mean age of 34.5 years and median CD4 count of 194 cells/μL were included. CKD prevalence was 13.4% (95%CI 11.6%-15.4%) using the CKD-EPI equation (without the race factor). Multivariable analysis identified increasing age and CD4 count <200 cells/μL as being independently associated with CKD occurrence.This study reports a high prevalence of CKD in ART-naïve HIV-infected patients. Measures to improve diagnosis of kidney disease and ensure early initiation of treatment should be integrated in HIV treatment programmes in this setting.
在人类免疫缺陷病毒（HIV）患者中广泛使用抗逆转录病毒疗法（ART），使得患者寿命延长，随之而来的是非传染性疾病患病率上升，其中包括慢性肾脏病（CKD）。本研究记录了尼日利亚南部大量HIV人群中CKD的患病率。这是一项针对未接受过ART治疗患者的单中心、为期15年的分析。CKD的定义为使用慢性肾脏病流行病学协作组（CKD-EPI）方程，在间隔3至12个月的连续两次检测中，估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²。分别采用 Cochr an-Armitage检验和Cuzick检验来评估CKD患病率和CD4细胞计数随年份的变化趋势。使用多变量逻辑回归模型来确定与CKD的独立关联。总共纳入了1317例患者（62.2%为女性），平均年龄为34.5岁，CD4细胞计数中位数为194个/μL。使用CKD-EPI方程（不考虑种族因素）时，CKD患病率为13.4%（95%CI 11.6%-15.4%）。多变量分析确定年龄增长和CD4细胞计数<200个/μL与CKD的发生独立相关。本研究报告了未接受过ART治疗的HIV感染患者中CKD的高患病率。在这种情况下，应将改善肾脏疾病诊断和确保早期开始治疗的措施纳入HIV治疗方案中。
