乌干达感染艾滋病毒的老年人中肾功能损害的患病率较高。

Higher prevalence of kidney function impairment among older people living with HIV in Uganda.

作者信息

Ssemasaazi Amutuhaire Judith, Kalyesubula Robert, Manabe Yukari C, Mbabazi Phoebe, Naikooba Susan, Ssekindi Faizo, Nasuuna Esther, Kibwika Pauline Byakika, Castelnuovo Barbara

机构信息

Makerere University College of Health Sciences.

Infectious Diseases Institute.

出版信息

Res Sq. 2024 May 13:rs.3.rs-4364155. doi: 10.21203/rs.3.rs-4364155/v1.

DOI:10.21203/rs.3.rs-4364155/v1

PMID:38798422

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11118683/

Abstract

BACKGROUND

People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in HIV-uninfected people in sub-Saharan Africa.

METHODS

We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment.

RESULTS

We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Overall, the prevalence of kidney function impairment was 23.0% (95% CI:18.4%-28.4%); 33.1% (95% CI: 25.7%-41.4%) versus 12.9% (95% CI: 8.3%-19.7%) among people living with and without HIV (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8%-52.3%) versus 19.4% (95% CI:13.6%-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04-7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07-1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06-3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02-4.67), p-value = 0.04) were significantly associated with kidney function impairment.

CONCLUSIONS

HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

摘要

背景

由于与艾滋病病毒相关的炎症、抗逆转录病毒疗法（ART）、糖尿病和高血压，艾滋病病毒感染者（PLWH）有肾功能损害的风险。随着年龄增长肾功能下降，老年人可能会经历更高的慢性肾脏病（CKD）负担。在撒哈拉以南非洲，将老年艾滋病病毒感染者肾功能损害的患病率与未感染艾滋病病毒者进行比较的数据很少。

方法

我们在乌干达坎帕拉对年龄≥60岁的艾滋病病毒感染者和未感染者进行了一项横断面研究，这些人按社区位置1:1匹配。我们收集了社会人口统计学、合并症和艾滋病病毒相关临床特征的数据。我们将肾功能损害定义为估计肾小球滤过率（eGFR）<60ml/min/1.73m²，无论有无蛋白尿。我们构建了多变量逻辑回归模型以研究参与者特征与肾功能损害之间的关联。

结果

我们纳入了278人（中位年龄66岁）；50%为艾滋病病毒感染者，51.8%为女性。总体而言，肾功能损害的患病率为23.0%（95%CI：18.4%-28.4%）；艾滋病病毒感染者中的患病率为33.1%（95%CI：25.7%-41.4%），未感染者中的患病率为12.9%（95%CI：8.3%-19.7%）（p值<0.01）。艾滋病病毒感染者与未感染艾滋病病毒者的蛋白尿患病率分别为43.9%（95%CI：35.8%-52.3%）和19.4%（95%CI：13.6%-26.9%），p值<0.01。感染艾滋病病毒（比值比[OR]=3.89（95%CI：2.04-7.41），p值<0.01）、年龄较大（OR=1.13，（95%CI：1.07-1.20），p值<0.01）、女性（OR=1.95，（95%CI：1.06-3.62），p值=0.03）以及既往诊断为高血压（OR=2.19（95%CI：1.