Abate Melsew Dagne, Kassa Mulat Awoke, Yilak Gizachew, Habtie Tesfaye Engdaw, Temesgen Dessie, Mulu Berihun, Feleke Sefineh Fenta, Baylie Amsalu, Bizuayehu Molla Azmeraw
Department of Adult Health Nursing, Injibara University, Injibara, Ethiopia
Department of Nursing, Woldia University, Woldia, Ethiopia.
BMJ Open. 2025 Jul 8;15(7):e090345. doi: 10.1136/bmjopen-2024-090345.
To assess the incidence, progression and predictors of chronic kidney disease among adult patients living with HIV/AIDS who are receiving antiretroviral therapy.
An institution-based, multicentre retrospective follow-up study was conducted among a randomly selected sample of 535 adult patients. Data were entered into Epi Data version 4.6.0 and analysed using STATA version 14.0. A Cox proportional hazards regression model was fitted to identify independent predictors of chronic kidney disease incidence. Variables with p<0.05 in the multivariable model were considered statistically significant.
The study was conducted at comprehensive specialised hospitals in the Amhara Region of Ethiopia. Adult patients with HIV/AIDS receiving follow-up antiretroviral therapy between 1 April 2012 and 31 September 2022 were the cohort participants.
Of the 528 adult patients included in the final analysis, 15 (2.84%) developed chronic kidney disease during the follow-up period, resulting in an overall incidence rate of 4.1 per 1000 person-years of observation. Significant predictors of chronic kidney disease included baseline age (adjusted HR (AHR)=1.053; 95% CI, 1.001 to 1.108), serum creatinine (AHR=1.698; 95% CI, 1.302 to 2.215), blood urea nitrogen (AHR=1.031; 95% CI, 1.001 to 1.061) and baseline viral load ≥1000 copies/mL (AHR=3.464; 95% CI, 1.104 to 10.871).
The incidence of chronic kidney disease among adult patients with HIV was clinically significant. Older age, baseline viral load ≥1000 and high blood urea nitrogen and creatinine levels were significant predictors of higher risk. Proactive measures, such as closer kidney monitoring, targeted care for older patients and ensuring optimal viral suppression with effective antiretroviral therapy, can delay or prevent the development of chronic kidney disease.
评估接受抗逆转录病毒治疗的成年艾滋病毒/艾滋病患者中慢性肾脏病的发病率、进展情况及预测因素。
在535名成年患者的随机抽样样本中开展了一项基于机构的多中心回顾性随访研究。数据录入Epi Data 4.6.0版本，并使用STATA 14.0版本进行分析。采用Cox比例风险回归模型来确定慢性肾脏病发病率的独立预测因素。多变量模型中p<0.05的变量被视为具有统计学意义。
该研究在埃塞俄比亚阿姆哈拉地区的综合专科医院进行。队列参与者为2012年4月1日至2022年9月31日期间接受随访抗逆转录病毒治疗的成年艾滋病毒/艾滋病患者。
在最终分析纳入的528名成年患者中，15名（2.84%）在随访期间发生了慢性肾脏病，总体发病率为每1000人年观察期4.1例。慢性肾脏病的显著预测因素包括基线年龄（调整后风险比（AHR）=1.053；95%置信区间，1.001至1.108）、血清肌酐（AHR=1.698；95%置信区间，1.302至2.215）、血尿素氮（AHR=1.031；95%置信区间，1.001至1.061）以及基线病毒载量≥1000拷贝/毫升（AHR=3.464；95%置信区间，1.104至10.871）。
成年艾滋病毒患者中慢性肾脏病的发病率具有临床意义。年龄较大、基线病毒载量≥1000以及血尿素氮和肌酐水平较高是风险较高的显著预测因素。采取积极措施，如加强肾脏监测、对老年患者进行针对性护理以及通过有效的抗逆转录病毒治疗确保最佳病毒抑制，可延缓或预防慢性肾脏病的发生。
