Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Noncommunicable Diseases Program, Entebbe, Uganda.
Infectious Diseases Institute, Makerere University, College of Health Sciences, Kampala, Uganda.
PLoS One. 2024 Nov 4;19(11):e0301954. doi: 10.1371/journal.pone.0301954. eCollection 2024.
Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA.
We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPLHIV aged 10-24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Laird random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger's test.
Of 802 retrieved articles, 15 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 12 (80%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only one study followed the standard definition of CKD. The pooled CKD prevalence from 15 studies was 12% (95% CI 6.0-19.5%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2 = 97.7%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach.
CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management.
PROSPERO registration number: CRD42022347588.
在全球范围内，HIV 感染者中的慢性肾脏病（CKD）发病率在年轻人中呈上升趋势，但估计结果不一致。在撒哈拉以南非洲（SSA），需要汇总 CKD 的流行率数据，以便为早期诊断和管理提供信息。我们进行了一项系统评价和荟萃分析，以评估 SSA 中 HIV 感染者中的 CKD 总体流行率。
我们使用预定义的搜索策略，在 Medline/PubMed、EMBASE、非洲医学索引和非洲期刊在线上搜索报告 SSA 中 HIV 感染者中 CKD 流行率的文章，截至 2024 年 1 月 15 日。对确定的文章的参考文献列表进行了检查，以查找其他合格的研究。纳入标准为：报告 CKD 流行率的 10-24 岁 HIV 感染者的研究，通过肾小球滤过率（GFR）、白蛋白-肌酐比（ACR）或蛋白尿定义。我们使用叙述性综述报告纳入研究之间的差异。使用 DerSimonian-Laird 随机效应模型汇总 CKD 流行率，并使用 Cochrane Q 检验和 I-squared 值评估异质性。我们使用 Joanna Briggs 研究所检查表评估每篇文章的偏倚风险，并使用漏斗图和 Egger 检验评估发表偏倚。
从 802 篇检索文章中，有 15 篇符合纳入标准并纳入荟萃分析。其中，12 篇（80%）为使用估计 GFR 诊断 CKD 的横断面研究。只有一项研究遵循了 CKD 的标准定义。来自 15 项研究的汇总 CKD 流行率为 12%（95%CI 6.0-19.5%），根据使用的定义，范围从 0.8%到 53.1%，异质性程度很高（I2 = 97.7%，p<0.001）。纳入的研究质量中等，没有发表偏倚的证据。敏感性分析表明，研究结果对方法学和分析方法具有稳健性。
HIV 感染者中的 CKD 发病率在 SSA 范围内处于中等偏高水平，且高度异质。应使用 CKD 的标准定义来估算不同研究和环境中的 CKD 流行率。纳入 HIV 感染者的 HIV 项目应常规筛查 CKD，以确保早期诊断和管理。
PROSPERO 注册号：CRD42022347588。
