Hung Rachel K Y, Santana-Suarez Beatriz, Binns-Roemer Elizabeth, Campbell Lucy, Bramham Kate, Hamzah Lisa, Fox Julie, Burns James E, Clarke Amanda, Vincent Rachel, Jones Rachael, Price David A, Onyango Denis, Harber Mark, Hilton Rachel, Booth John W, Sabin Caroline A, Winkler Cheryl A, Post Frank A
King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK.
Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA.
EClinicalMedicine. 2021 Jul 8;38:101006. doi: 10.1016/j.eclinm.2021.101006. eCollection 2021 Aug.
Chronic kidney disease (CKD) is a leading cause of morbidity and mortality globally. The risk of CKD is increased in people of African ancestry and with Human Immunodeficiency Virus (HIV) infection.
We conducted a cross-sectional study investigating the relationship between region of ancestry (East, Central, South or West Africa) and kidney disease in people of sub-Saharan African ancestry with HIV in the UK between May 2018 and February 2020. The primary outcome was renal impairment (estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m). Secondary outcomes were stage 5 CKD (eGFR <15 ml/min/1.73 m, on dialysis for over 3 months or who had received a kidney transplant), proteinuria (urine protein/creatinine ratio >50 mg/mmol), and biopsy-confirmed HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS) or arterionephrosclerosis. Multivariable robust Poisson regression estimated the effect of region of African ancestry on kidney disease outcomes.
Of the 2468 participants (mean age 48.1 [SD 9.8] years, 62% female), 193 had renal impairment, 87 stage 5 CKD, 126 proteinuria, and 43 HIVAN/FSGS or arterionephrosclerosis. After adjusting for demographic characteristics, HIV and several CKD risk factors and with East African ancestry as referent, West African ancestry was associated with renal impairment (prevalence ratio [PR] 2.06 [95% CI 1.40-3.04]) and stage 5 CKD (PR 2.23 [1.23-4.04]), but not with proteinuria (PR 1.27 [0.78-2.05]). West African ancestry (as compared to East/South African ancestry) was also strongly associated with a diagnosis of HIVAN/FSGS or arterionephrosclerosis on kidney biopsy (PR 6.44 [2.42-17.14]).
Our results indicate that people of West African ancestry with HIV are at increased risk of kidney disease. Although we cannot rule out the possibility of residual confounding, geographical region of origin appears to be a strong independent risk factor for CKD as the association did not appear to be explained by several demographic, HIV or renal risk factors.
慢性肾脏病（CKD）是全球发病和死亡的主要原因。非洲裔人群以及感染人类免疫缺陷病毒（HIV）的人群患CKD的风险增加。
我们进行了一项横断面研究，调查2018年5月至2020年2月期间在英国的撒哈拉以南非洲裔HIV感染者的祖籍地区（东非、中非、南非或西非）与肾脏疾病之间的关系。主要结局是肾功能损害（估计肾小球滤过率[eGFR]<60 ml/min/1.73 m²）。次要结局包括5期CKD（eGFR<15 ml/min/1.73 m²，透析超过3个月或接受过肾移植）、蛋白尿（尿蛋白/肌酐比值>50 mg/mmol）以及活检确诊的HIV相关性肾病（HIVAN）、局灶节段性肾小球硬化（FSGS）或动脉性肾硬化。多变量稳健泊松回归估计了非洲祖籍地区对肾脏疾病结局的影响。
在2468名参与者（平均年龄48.1[标准差9.8]岁，62%为女性）中，193人有肾功能损害，87人患有5期CKD，126人有蛋白尿，43人患有HIVAN/FSGS或动脉性肾硬化。在调整了人口统计学特征、HIV及多种CKD危险因素后，以东非祖籍为参照，西非祖籍与肾功能损害（患病率比[PR]2.06[95%CI 1.40 - 3.04]）和5期CKD（PR 2.23[1.23 - 4.04]）相关，但与蛋白尿无关（PR 1.27[0.78 - 2.05]）。与东非/南非祖籍相比，西非祖籍在肾脏活检时也与HIVAN/FSGS或动脉性肾硬化的诊断密切相关（PR 6.44[2.42 - 17.14]）。
我们的结果表明，感染HIV的西非裔人群患肾脏疾病的风险增加。尽管我们不能排除残留混杂因素的可能性，但祖籍地理区域似乎是CKD的一个强大独立危险因素，因为这种关联似乎无法用多种人口统计学、HIV或肾脏危险因素来解释。
