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[Preprint]. 2024 Sep 3:2024.09.02.24312932.
doi: 10.1101/2024.09.02.24312932.

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

Esther M Nasuuna  1   2 , Laurie A Tomlinson  3 , Robert Kalyesubula  1   4 , Chido Dziva Chikwari  5   6 , Barbara Castelnuovo  1 , Yukari C Manabe  2   7 , Damalie Nakanjako  2   8 , Helen A Weiss  6
Affiliations

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

Esther M Nasuuna et al. medRxiv. .

Update in

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 <60ml/min/1.73m2 or <90ml/min/1.73m2 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.

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 0-23% 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).

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.

Keywords: Africa; HIV; HIV comorbidities; chronic kidney disease; prevalence; young people.

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Conflict of interest statement

Competing interests The authors declare no conflict of interest.

Figures

Figure 1:
Figure 1:
Relationship between serum creatinine and cystatin C and age for males and females
Figure 2.
Figure 2.. Kernel density plot showing the distribution of the eGFR according to different estimating equations and biomarkers.
Scr serum creatinine, CG cockroft Gault, cys Cystatin C
Figure 3
Figure 3
Prevalence of CKD according to the different estimating equations and biomarkers.
See this image and copyright information in PMC

References

    1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022;12(1):7–11. - PMC - PubMed
    1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. American Journal of Kidney Disease 39:S1–S266. 2002. - PubMed
    1. Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The lancet. 2020;395(10225):709–33. - PMC - PubMed
    1. Fabian J, Kalyesubula R, Mkandawire J, Hansen CH, Nitsch D, Musenge E, et al. Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study. The Lancet Global Health. 2022;10(8):e1159–e69. - PubMed
    1. Fabian J, George JA, Etheredge HR, van Deventer M, Kalyesubula R, Wade AN, et al. Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa. Clinical Kidney Journal. 2019;12(6):778–87. - PMC - PubMed

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