HIV 感染者和未感染者成年人肾功能受损的风险因素：坦桑尼亚西北部的横断面研究。
Risk factors for impaired renal function in HIV-infected and HIV-uninfected adults: cross-sectional study in North-Western Tanzania.
机构信息
Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
出版信息
BMC Nephrol. 2021 Oct 29;22(1):355. doi: 10.1186/s12882-021-02563-z.
BACKGROUND
Although the burden of impaired renal function is rising in sub-Saharan Africa (SSA), little is known about correlates of impaired renal function in the region. We determined factors associated with estimated glomerular filtration rate (eGFR) and impaired renal function in HIV-infected and HIV-uninfected adults.
METHODS
We undertook cross-sectional analysis of data from 1947 adults at enrolment for a cohort study on diabetes and associated complications in HIV patients in Mwanza, north-western Tanzania. A structured questionnaire was used to collect data on sociodemography, smoking, alcohol, physical activity, antiretroviral therapy (ART) and anthropometry. We measured blood pressure, tested blood samples for creatinine, glucose and HIV, and performed Kato Katz for Schistosoma mansoni. Correlates of eGFR (mL/min/1.73 m) and impaired renal function (eGFR< 60 mL/min/1.73 m) were determined using linear regression and logistic regression, respectively.
RESULTS
655 (34%) participants were HIV-uninfected, 956 (49%) were ART-naive HIV-infected and 336 (17%) were HIV-infected adults on ART. The mean age was 41 years (SD12) and majority (59%) were females. Overall, the mean eGFR was 113.6 mL/min/1.73 m but 111.2 mL/min/1.73 m in HIV-uninfected, 109.7 mL/min/1.73 m in ART-naive HIV-infected and 129.5 mL/min/1.73 m in HIV-infected ART-experienced adults, and respective prevalence of impaired renal function was 7.0, 5.7, 8.1 and 6.3%. Correlates of lower eGFR were increasing age, higher socioeconomic status, unhealthy alcohol drinking, higher body mass index and diabetes mellitus. Anaemia was associated with 1.9 (95% Confidence Interval (CI):1.2, 2.7, p = 0.001) higher odds of impaired renal function compared to no anaemia and this effect was modified by HIV status (p value 0.02 for interaction).
CONCLUSION
Impaired renal function is prevalent in this middle-aged study population. Interventions for prevention of impaired renal function are needed in the study population with special focus in HIV-infected adults and those with high socioeconomic status. Interventions targeting modifiable risk factors such as alcohol and weight reduction are warranted.
背景
尽管撒哈拉以南非洲（SSA）地区肾功能受损的负担正在增加，但人们对该地区肾功能受损的相关因素知之甚少。我们确定了与 HIV 感染和未感染成年人估算肾小球滤过率（eGFR）和肾功能受损相关的因素。
方法
我们对坦桑尼亚西北部姆万扎的一项关于 HIV 患者糖尿病及其相关并发症的队列研究中 1947 名成年人的登记数据进行了横断面分析。使用结构化问卷收集社会人口统计学、吸烟、饮酒、身体活动、抗逆转录病毒治疗（ART）和人体测量学数据。我们测量了血压，检测了血液样本中的肌酐、葡萄糖和 HIV，并进行了加藤氏粪便检查以检测曼氏血吸虫。使用线性回归和逻辑回归分别确定 eGFR（mL/min/1.73m）和肾功能受损（eGFR<60mL/min/1.73m）的相关因素。
结果
655 名（34%）参与者未感染 HIV，956 名（49%）为初治 HIV 感染的抗逆转录病毒治疗（ART）-naive HIV 感染者，336 名（17%）为接受 ART 的 HIV 感染成年人。平均年龄为 41 岁（SD12），大多数（59%）为女性。总体而言，平均 eGFR 为 113.6mL/min/1.73m，但在未感染 HIV 的成年人中为 111.2mL/min/1.73m，在初治 HIV 感染的成年人中为 109.7mL/min/1.73m，在接受 ART 的 HIV 感染成年人中为 129.5mL/min/1.73m，肾功能受损的患病率分别为 7.0%、5.7%、8.1%和 6.3%。较低的 eGFR 与年龄增长、较高的社会经济地位、不健康的饮酒、较高的体重指数和糖尿病有关。与无贫血相比，贫血与肾功能受损的几率增加 1.9 倍（95%置信区间（CI）：1.2，2.7，p=0.001），并且这种影响受 HIV 状态的修饰（p 值为 0.02 表示交互作用）。
结论
在这个中年研究人群中，肾功能受损很常见。需要在研究人群中针对肾功能受损采取预防措施，特别关注 HIV 感染的成年人和社会经济地位较高的成年人。有必要针对可改变的风险因素（如饮酒和减重）进行干预。
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