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. 2021 Feb;22(2):113-121.
doi: 10.1111/hiv.12982. Epub 2020 Nov 3.

Validation of the D:A:D chronic kidney disease risk score in people living with HIV: the IeDEA West Africa Cohort Collaboration

A Poda  1 , N F Kabore  2 , K Malateste  3 , N De Rekeneire  2 , A Semde  4 , Y Bikinga  5 , A Patassi  6 , H Chenal  7 , E Messou  8 , F Dabis  9 , D K Ekouevi  10 , A Jaquet  3 , A Cournil  11
Affiliations

Validation of the D:A:D chronic kidney disease risk score in people living with HIV: the IeDEA West Africa Cohort Collaboration

A Poda et al. HIV Med. 2021 Feb.

Abstract

Objectives: A risk score for long-term prediction of chronic kidney disease (CKD) in people living with HIV (PLHIV) has been developed using data from the D:A:D cohort. We assessed the performance of the D:A:D risk score in a cohort of PLHIV in West Africa.

Methods: Data from PLHIV starting antiretroviral treatment in four clinics in Burkina Faso, Côte d'Ivoire and Togo participating in the IeDEA West Africa collaboration were analysed. CKD was defined as two consecutive estimated glomerular filtration rates (eGFRs) of ≤ 60 mL/min/1.73 m2 . The D:A:D score (short version) was calculated using age, gender, nadir CD4 and baseline eGFR and was categorized into low, medium, and high-risk groups.

Results: In 14 930 participants (70% female, median age = 38 years; median nadir CD4 count = 183 cells/µL) followed for a median duration of 5.7 years, 660 (4.4%) progressed to CKD, with an incidence [95% confidence interval (CI)] of 7.8 (7.2-8.4) per 1000 person-years (PY). CKD incidence rates were 2.4 (2.0-2.8), 8.1 (6.8-9.6) and, 30.9 (28.0-34.1) per 1000 PY in the low-, medium- and high-risk groups, respectively. In the high-risk group, 14.7% (95% CI: 13.3; 16.3) had progressed to CKD at 5 years. Discrimination was good [C-statistics = 0.81 (0.79-0.83)]. In all, 79.4% of people who progressed to CKD were classified in the medium- to high-risk group at baseline (sensitivity) and 66.5% of people classified in the low risk group at baseline did not progress to CKD (specificity).

Conclusions: These findings confirm the validity of the D:A:D score in identifying individuals at risk of developing CKD who could benefit from enhanced kidney monitoring in West African HIV clinics.

Keywords: HIV; West Africa; cohort study; renal disease; risk score validation.

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Conflict of interest statement

Conflict of interest: The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Initiation of a tenofovir disoproxyl fumarate (TDF)-based regimen and progression to chronic kidney disease (CKD). Individuals were classified as TDF-exposed (TDF) if they were receiving TDF at baseline or if they started a TDF-based regimen within 6 months of the baseline visit. Incidence rate ratios for progression to CKD were estimated using a variable combining risk score category and TDF exposure.
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References

    1. Cohen SD, Kopp JB, Kimmel PL. Kidney Diseases Associated with Human Immunodeficiency Virus Infection. N Engl J Med 2017; 377 (24): 2363–74. - PubMed
    1. Rosenberg AZ, Naicker S, Winkler CA et al. HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment. Nat Rev Nephrol 2015; 11 (3): 150–60. - PubMed
    1. Swanepoel CR, Atta MG, D’Agati VD et al. Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2018; 93 (3): 545–59. - PMC - PubMed
    1. ElHafeez SA, Bolignano D, D’Arrigo G et al. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open 2018; 8 (1): e015069. - PMC - PubMed
    1. Mocroft A, Lundgren JD, Ross M et al. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A: D study. PLoS Medicine 2015; 12 (3): e1001809. - PMC - PubMed

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