撒哈拉以南非洲国家 HIV 感染合并慢性肾脏病患者的临床特点及预后：来自喀麦隆的实例研究。
Clinical characteristics and outcome of HIV infected patients with chronic kidney disease in Sub Saharan Africa: an example from in Cameroon.
机构信息
Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
Department of Internal Medicine, Douala General Hospital, PO Box: 4856, Douala, Cameroon.
出版信息
BMC Nephrol. 2019 Jul 9;20(1):253. doi: 10.1186/s12882-019-1446-3.
BACKGROUND
Chronic kidney disease (CKD) is one of the major complications of Human immune deficiency Virus (HIV) and a risk factor for poor outcome of these patients. We aimed to describe the profile and outcome of HIV positive patients with CKD in Douala general hospital in Cameroon.
METHODS
HIV positive patients with CKD referred to the nephrologist from January 2007 to March 2013 were included. Socio demographic, clinical (history and stage of HIV, comorbidities, baseline nephropathy, used of c-ART), para clinical data at referral (serum urea, creatinine, full blood count, CD4 count, serum calcium, phosphorus, albumin), dialysis initiation and outcome at 1 year were collected from medical records. GFR was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined and classified according to the Kidney Disease Improving Global Outcomes (KDIGO 2012).
RESULTS
We included 156 patients (51.3% men) with a mean age of 45.4 ± 12.1 years. Hypertension (36.5%), diabetes (17.9%) and Hepatitis C (7.7%) were the main comorbidities. HIV associated nephropathy (27.6%), chronic glomerulonephritis (15.4%) diabetes (14.1%) and hypertension (13.5%) were the leading causes of kidney disease. Before referral HIV status was known by 109 (69.9%) patients, with 76 (69.7%) being on c-ART. Median CD count was 241 (117-438) cells/mm. Prevalence of anemia (93.9%), hypocalcemia (68.6%) and Proteinuria (77.6%) was high, 94 (60.3%) patients were at CKD stage 5 at referral and 37 (23.7%) underwent emergency dialysis. After 1 year, 64 (41.0%) patients were lost to follow up. The mortality rate was 49% and 25 (28.7%) were maintenance hemodialysis, and being on c-ART was associated with a lower risk of death (HR: 0.45; 95% CI: 0.23-0.89; p = 0.021).
CONCLUSION
HIV patients with CKD were referred late with high morbidity and need for urgent hemodialysis. HIVAN was the main etiology of CKD and mortality rate was high mainly due to the absence of c-ART at referral.
背景
慢性肾脏病（CKD）是人类免疫缺陷病毒（HIV）的主要并发症之一，也是这些患者预后不良的一个风险因素。我们旨在描述喀麦隆杜阿拉综合医院 HIV 阳性合并 CKD 患者的特征和结局。
方法
我们纳入了 2007 年 1 月至 2013 年 3 月间转诊至肾病科的 HIV 阳性合并 CKD 患者。从病历中收集了人口统计学、临床（HIV 病史和分期、合并症、基线肾病、c-ART 使用情况）、实验室数据（血清尿素、肌酐、全血细胞计数、CD4 计数、血清钙、磷、白蛋白）、开始透析及 1 年结局。使用慢性肾脏病流行病学合作（CKD-EPI）方程估算肾小球滤过率（GFR）。根据肾脏疾病改善全球结局（KDIGO 2012）标准定义和分类 CKD。
结果
我们纳入了 156 名患者（51.3%为男性），平均年龄为 45.4±12.1 岁。高血压（36.5%）、糖尿病（17.9%）和丙型肝炎（7.7%）是主要合并症。HIV 相关肾病（27.6%）、慢性肾小球肾炎（15.4%）、糖尿病（14.1%）和高血压（13.5%）是导致肾脏疾病的主要原因。在转诊前，有 109 名（69.9%）患者已知 HIV 感染状态，其中 76 名（69.7%）正在接受 c-ART。中位 CD 计数为 241（117-438）个细胞/mm。贫血（93.9%）、低钙血症（68.6%）和蛋白尿（77.6%）的发生率较高，94 名（60.3%）患者转诊时已处于 CKD 5 期，37 名（23.7%）患者行紧急透析。1 年后，有 64 名（41.0%）患者失访。死亡率为 49%，25 名（28.7%）患者接受维持性血液透析，接受 c-ART 与降低死亡风险相关（HR：0.45；95%CI：0.23-0.89；p=0.021）。
结论
HIV 合并 CKD 患者就诊较晚，合并症发病率高，需要紧急血液透析。HIVAN 是 CKD 的主要病因，死亡率高主要是由于转诊时未使用 c-ART。
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