Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
BMC Nephrol. 2024 Aug 23;25(1):270. doi: 10.1186/s12882-024-03711-x.
Chronic kidney disease (CKD) affects almost 10% of the global populace including people living with HIV (PLWH). PLWH acquire CKD from both traditional and HIV-specific CKD risk factors. This study aimed to determine the prevalence of CKD and associated factors among antiretroviral therapy (ART) naïve PLWH in Lagos, Nigeria. METHODS: This is a secondary data analysis among adult (≥ 18 years) ART-naïve PLWH enrolled at a large ART clinic in Lagos over 6 years. CKD was defined as estimated glomerular filtration rates (eGFR) below 60ml/min/1.73m over 3 months. Three estimators [Body surface area corrected Cockcroft Gault (BSA-CG), Modification of Diet in Renal Disease (MDRD), Chronic kidney disease Epidemiology Collaboration (CKD-EPI)] were used to determine the burden of CKD with no race correction factor. Age- and sex-standardised prevalence rates were determined. Cohen Kappa and Spearman correlations were used to compare the estimators. Logistic regressions were applied to identify variables associated with prevalent CKD.
Among 2 772 PLWH, the mean age was 38 years with males older than females (p < 0.001). The majority of participants were females (62.1%), married (54.8%), employed (85.7%), had underweight or normal body mass index (BMI) (62.2%), and were diagnosed with World Health Organization (WHO) clinical stages 1 and 2 (55.5%). The age- and sex-standardised prevalence of CKD ranged from 10.0 - 17.6% with the highest Spearman's correlation (0.928) observed with MDRD and CKD-EPI equations. Increasing age [AOR (95% CI), equation] was significantly associated with CKD across all equations [1.09 (1.06 - 1.13), BSA-CG; 1.07 (1.05 - 1.10), MDRD; 1.09 (1.06 -1.12), CKD-EPI]. Other variables associated with CKD [AOR (95% CI), equation] were anaemia [2.50 (1.34 - 4.68), BSA-CG; 1.73 (1.04 - 2.86), MDRD], BMI <25 kg/m [3.35 (1.55 - 7.26), BSA-CG; 2.02 (1.18 - 3.46), CKD-EPI], and CD4 counts ≤ 200 cells/µL [2.02 (1.06 - 3.87), BSA-CG].
There was a high prevalence of CKD among ART-naïve PLWH at enrollment, which highlights the need to evaluate this population for CKD. Aside increasing age and low CD4 counts, none of the traditional or HIV-specific risk factors were related to CKD diagnosis.
慢性肾脏病（CKD）影响着全球近 10%的人口，包括艾滋病毒感染者（PLWH）。PLWH 从传统和 HIV 特异性 CKD 风险因素中获得 CKD。本研究旨在确定在尼日利亚拉各斯接受抗逆转录病毒治疗（ART）的初治 PLWH 中 CKD 的患病率及其相关因素。
这是在拉各斯一家大型 ART 诊所中，对在 6 年内接受初治 PLWH 的成年人（≥18 岁）进行的二次数据分析。CKD 的定义为在 3 个月内估计肾小球滤过率（eGFR）低于 60ml/min/1.73m。使用三种估算器[校正后的体表面积 Cockcroft-Gault（BSA-CG）、肾脏病饮食改良（MDRD）、慢性肾脏病流行病学合作（CKD-EPI）]来确定没有种族校正因子的 CKD 负担。确定了年龄和性别标准化的患病率。使用 Cohen Kappa 和 Spearman 相关性来比较估算器。应用逻辑回归来确定与常见 CKD 相关的变量。
在 2772 名 PLWH 中，平均年龄为 38 岁，男性比女性年龄大（p<0.001）。大多数参与者为女性（62.1%）、已婚（54.8%）、有工作（85.7%）、体重指数（BMI）为低体重或正常（62.2%），且被诊断为世界卫生组织（WHO）临床分期 1 和 2（55.5%）。CKD 的年龄和性别标准化患病率为 10.0-17.6%，与 MDRD 和 CKD-EPI 方程的最高 Spearman 相关性（0.928）观察到。所有方程中，年龄[比值比（95%置信区间），方程]均与 CKD 显著相关[1.09（1.06-1.13），BSA-CG；1.07（1.05-1.10），MDRD；1.09（1.06-1.12），CKD-EPI]。其他与 CKD [比值比（95%置信区间），方程]相关的变量是贫血[2.50（1.34-4.68），BSA-CG；1.73（1.04-2.86），MDRD]、BMI<25kg/m[3.35（1.55-7.26），BSA-CG；2.02（1.18-3.46），CKD-EPI]和 CD4 计数≤200 个/μL[2.02（1.06-3.87），BSA-CG]。
在初治 PLWH 中，CKD 的患病率很高，这表明需要对这一人群进行 CKD 评估。除了年龄增长和低 CD4 计数外，传统或 HIV 特异性风险因素均与 CKD 诊断无关。
