Nasuuna Esther M, Tomlinson Laurie A, Kalyesubula Robert, Chikwari Chido Dziva, Castelnuovo Barbara, Manabe Yukari C, Nakanjako Damalie, Weiss Helen A
Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe Uganda.
Infectious Diseases Institute, Makerere University, College of Health Sciences, Kampala, Uganda.
medRxiv. 2024 Sep 3:2024.09.02.24312932. doi: 10.1101/2024.09.02.24312932.
Young people living with HIV (YPLHIV) are at increased risk of developing chronic kidney disease (CKD) which is associated with high mortality and morbidity. Early diagnosis is important to halt progression. We aimed to estimate the prevalence and factors associated with CKD among YPLHIV in Kampala, Uganda, and to compare serum creatinine and cystatin C for early diagnosis of CKD in this population.
A cross-sectional study with YPLHIV aged 10 to 24 years was conducted in seven HIV clinics. Participants provided a urine and blood sample to measure urinary albumin, proteinuria, serum creatinine and cystatin C levels at baseline and after three months. The estimated glomerular filtration rate (eGFR) was calculated using CKDEPI 2021, Cockroft-Gault and bedside Schwartz equations using creatinine or cystatin C. The albumin creatinine ratio (ACR) and proteinuria were measured. CKD was defined as either eGFR <60ml/min/1.73m or <90ml/min/1.73m or ACR above 30mg/g on two separate occasions. Univariable and multivariable logistic regression were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with CKD.
A total of 500 participants were enrolled. Most were female (56%; n=280) and aged 10 to 17 years (66.9%; n=335). CKD prevalence ranged from 0-23% depending on the criteria, equation and biomarker used. Cystatin C-based equations estimated higher prevalence of CKD compared to creatinine-based ones. Prevalence of ACR above 30mg/g was 10.1% and of proteinuria 29%. Factors independently associated with CKD were age (aOR=1.42; 95% CI:1.30-1.51) and male sex (aOR=3.02; 95% CI:1.68-5.43).
CKD prevalence among YPLHIV varied substantially depending on definitions used and the current definition would likely lead to missed cases of CKD among YPLHIV. Estimating equations should be validated against measured GFR in YPLHIV and the optimal definition of CKD in this vulnerable population should be revised to optimise detection and opportunities for reducing disease progression.
感染艾滋病毒的年轻人（YPLHIV）患慢性肾脏病（CKD）的风险增加，这与高死亡率和高发病率相关。早期诊断对于阻止疾病进展很重要。我们旨在估计乌干达坎帕拉YPLHIV中CKD的患病率及相关因素，并比较血清肌酐和胱抑素C在该人群中对CKD的早期诊断价值。
在七家艾滋病毒诊所对年龄在10至24岁的YPLHIV进行了一项横断面研究。参与者在基线和三个月后提供尿液和血液样本，以测量尿白蛋白、蛋白尿、血清肌酐和胱抑素C水平。使用CKDEPI 2021、Cockcroft - Gault和床边施瓦茨方程，根据肌酐或胱抑素C计算估计肾小球滤过率（eGFR）。测量白蛋白肌酐比值（ACR）和蛋白尿。CKD的定义为eGFR<60ml/min/1.73m或<90ml/min/1.73m，或两次单独测量时ACR高于30mg/g。使用单变量和多变量逻辑回归来估计与CKD相关因素的调整比值比（aOR）和95%置信区间（CI）。
共招募了500名参与者。大多数为女性（56%；n = 280），年龄在10至17岁之间（66.9%；n = 335）。根据所使用的标准、方程和生物标志物，CKD患病率在0 - 23%之间。与基于肌酐的方程相比，基于胱抑素C的方程估计的CKD患病率更高。ACR高于30mg/g的患病率为10.1%，蛋白尿患病率为29%。与CKD独立相关的因素是年龄（aOR = 1.42；95% CI：1.30 - 1.51）和男性（aOR = 3.02；95% CI：1.68 - 5.43）。
YPLHIV中CKD的患病率因所使用的定义而异，当前定义可能会导致YPLHIV中CKD病例的漏诊。估计方程应在YPLHIV中根据测量的GFR进行验证，并且应修订这一弱势群体中CKD的最佳定义，以优化检测和减少疾病进展的机会。
