比较乌干达 HIV 感染者中通过血清肌酐或胱抑素 C 诊断的慢性肾脏病的患病率及其相关因素。

Comparison of the prevalence and associated factors of chronic kidney disease diagnosed by serum creatinine or cystatin C among young people living with HIV in Uganda.

机构信息

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.

出版信息

BMC Nephrol. 2024 Nov 25;25(1):422. doi: 10.1186/s12882-024-03865-8.

DOI:10.1186/s12882-024-03865-8

PMID:39587464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11590532/

Abstract

INTRODUCTION

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.

METHODS

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 < 60 ml/min/1.73m or < 90 ml/min/1.73m or ACR above 30 mg/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.

RESULTS

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 to 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 30 mg/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).

CONCLUSION

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.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

介绍

年轻的 HIV 感染者（YPLHIV）患慢性肾脏病（CKD）的风险增加，这种疾病与高死亡率和发病率有关。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的 YPLHIV 中 CKD 的患病率和相关因素，并比较血清肌酐和胱抑素 C 在该人群中的早期诊断价值。

方法

在 7 家 HIV 诊所进行了一项年龄在 10 至 24 岁之间的 YPLHIV 横断面研究。参与者在基线和三个月时提供尿液和血液样本，以测量尿液白蛋白、蛋白尿、血清肌酐和胱抑素 C 水平。使用 CKDEPI 2021、Cockroft-Gault 和床边 Schwartz 方程，使用肌酐或胱抑素 C 计算估算肾小球滤过率（eGFR）。测量白蛋白肌酐比（ACR）和蛋白尿。CKD 的定义为 eGFR<60 ml/min/1.73m 或<90 ml/min/1.73m，或两次 ACR 均超过 30 mg/g。使用单变量和多变量逻辑回归估计与 CKD 相关的因素的调整后比值比（aOR）和 95%置信区间（CI）。

结果

共纳入 500 名参与者。大多数为女性（56%；n=280），年龄为 10 至 17 岁（66.9%；n=335）。根据标准、方程和生物标志物的不同，CKD 的患病率在 0 至 23%之间。基于胱抑素 C 的方程估计的 CKD 患病率高于基于肌酐的方程。ACR 超过 30mg/g 的患病率为 10.1%，蛋白尿的患病率为 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）。