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

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  4   5 , Chido Dziva Chikwari  6   7 , Barbara Castelnuovo  8 , Yukari C Manabe  8   9 , Damalie Nakanjako  8   10 , Helen A Weiss  7
Affiliations
Comparative Study

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. BMC Nephrol. .

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

Keywords: Africa; Chronic kidney disease; HIV; HIV comorbidities; Prevalence; Young people.

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Conflict of interest statement

Declarations. Human ethics and consent to participate declarations: Ethical approval was received from the Uganda Virus Research Institute (UVRI) Research Ethics Committee (reference number GC/127/946), the Uganda National Council of Science and Technology (HS2578ES) and the London School of Hygiene and Tropical Medicine institutional review board (28797). Information about the study appropriate for adults, semi-literate adults and children was provided in an information booklet that was read to the participants and caregivers. All the participants more than 18 years of age provided written informed consent. Those below 18 years of age provided assent, and their caregivers provided written informed consent. If a child refused to provide assent even after their caregiver had provided consent, that child was not enrolled into the study. All participants had the option to withdraw at any point during the research. All participants with suspected CKD were referred to a nephrologist for management. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between serum creatinine and cystatin C and age for males and females Sample size was 494
Fig. 2
Fig. 2
Kernel density plot showing the distribution of the eGFR according to different estimating equations and biomarkers
Fig. 3
Fig. 3
Prevalence of CKD according to the different estimating equations and biomarkers Sample size was 494
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References

    1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int 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. Am J Kidney Disease. 2002;39:S1–266. - 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. 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. Lancet Global Health. 2022;10(8):e1159–69. - 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. Clin Kidney J. 2019;12(6):778–87. - PMC - PubMed

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