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The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi

BACKGROUND: Chronic kidney disease (CKD) poses a major health threat to people living in low- and middle-income countries, especially when it is combined with HIV, antiretroviral treatment (ART) or communicable and non-communicable diseases. Data about the prevalence of CKD and its association with...

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Autores principales: Glaser, Nicola, Phiri, Sam, Bruckner, Tom, Nsona, Dominic, Tweya, Hannock, Ahrenshop, Nomeda, Neuhann, Florian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118906/
https://www.ncbi.nlm.nih.gov/pubmed/27875991
http://dx.doi.org/10.1186/s12882-016-0403-7
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author Glaser, Nicola
Phiri, Sam
Bruckner, Tom
Nsona, Dominic
Tweya, Hannock
Ahrenshop, Nomeda
Neuhann, Florian
author_facet Glaser, Nicola
Phiri, Sam
Bruckner, Tom
Nsona, Dominic
Tweya, Hannock
Ahrenshop, Nomeda
Neuhann, Florian
author_sort Glaser, Nicola
collection PubMed
description BACKGROUND: Chronic kidney disease (CKD) poses a major health threat to people living in low- and middle-income countries, especially when it is combined with HIV, antiretroviral treatment (ART) or communicable and non-communicable diseases. Data about the prevalence of CKD and its association with other diseases is scarce, particularly in HIV-negative individuals. This study estimated the prevalence of CKD in individuals who were either HIV-positive (and ART-naïve) or HIV-negative in an urban Malawian population. METHODS: This cross-sectional study was conducted at a HIV Testing and Counselling Centre in Lilongwe, Malawi. Consecutive clients who were ≥18 years and consented to participate were enrolled over a 3-month period. Clients were screened for potential renal disease and other conditions. Their blood pressure was measured, urine examined via dipstick and albumin/creatinine ratio and blood drawn for creatinine, cystatin C and sero-markers for schistosomiasis. Estimated glomerular filtration (eGFR) rate was calculated using a cystatin C-based formula and classified according to the matching CKD stages by K/DOQI (The National Kidney Foundation Kidney Disease Outcome Quality Initiative). We performed a descriptive analysis and compared differences between HIV-positive (and ART naïve) and -negative participants. RESULTS: Out of 381 consecutive clients who were approached between January and March 2012, 366 consented and 363 (48% female; 32% HIV-positive) were included in the analysis. Reasons for exclusion were missing samples or previous use of ART. HIV-positive and negative clients did not differ significantly with regard to age, sex or medical history, but they did differ for BMI—21.3 (±3.4) vs. 24 (±5.1), respectively (p < 0.001). Participants also differed with regard to serum cystatin C levels, but not creatinine. Reduced kidney function (according to CKD stages 2–5) was significantly more frequent 15.5 vs. 3.6%, respectively (p < 0.001) among HIV-positive clients compared to the HIV-negative group. Differences in renal function were most pronounced in the eGFR range 60–89 ml/min/1.73 m(2) accompanied by proteinuria with results as 11.2% vs. 1.2%, respectively for clients who were HIV-positive vs. HIV-negative (p = 0.001). CONCLUSIONS: Reduced glomerular filtration and/or proteinuria occurred in 15.5% of HIV-positive, and 3.6% of HIV-negative patients in this urban Malawian cohort. Since generalized renal monitoring is not feasible in Malawi or other resource-limited countries, strategies to identify patients at risk for higher stages of CKD and appropriate preventive measures are needed for both HIV-positive and HIV-negative patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0403-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-51189062016-11-28 The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi Glaser, Nicola Phiri, Sam Bruckner, Tom Nsona, Dominic Tweya, Hannock Ahrenshop, Nomeda Neuhann, Florian BMC Nephrol Research Article BACKGROUND: Chronic kidney disease (CKD) poses a major health threat to people living in low- and middle-income countries, especially when it is combined with HIV, antiretroviral treatment (ART) or communicable and non-communicable diseases. Data about the prevalence of CKD and its association with other diseases is scarce, particularly in HIV-negative individuals. This study estimated the prevalence of CKD in individuals who were either HIV-positive (and ART-naïve) or HIV-negative in an urban Malawian population. METHODS: This cross-sectional study was conducted at a HIV Testing and Counselling Centre in Lilongwe, Malawi. Consecutive clients who were ≥18 years and consented to participate were enrolled over a 3-month period. Clients were screened for potential renal disease and other conditions. Their blood pressure was measured, urine examined via dipstick and albumin/creatinine ratio and blood drawn for creatinine, cystatin C and sero-markers for schistosomiasis. Estimated glomerular filtration (eGFR) rate was calculated using a cystatin C-based formula and classified according to the matching CKD stages by K/DOQI (The National Kidney Foundation Kidney Disease Outcome Quality Initiative). We performed a descriptive analysis and compared differences between HIV-positive (and ART naïve) and -negative participants. RESULTS: Out of 381 consecutive clients who were approached between January and March 2012, 366 consented and 363 (48% female; 32% HIV-positive) were included in the analysis. Reasons for exclusion were missing samples or previous use of ART. HIV-positive and negative clients did not differ significantly with regard to age, sex or medical history, but they did differ for BMI—21.3 (±3.4) vs. 24 (±5.1), respectively (p < 0.001). Participants also differed with regard to serum cystatin C levels, but not creatinine. Reduced kidney function (according to CKD stages 2–5) was significantly more frequent 15.5 vs. 3.6%, respectively (p < 0.001) among HIV-positive clients compared to the HIV-negative group. Differences in renal function were most pronounced in the eGFR range 60–89 ml/min/1.73 m(2) accompanied by proteinuria with results as 11.2% vs. 1.2%, respectively for clients who were HIV-positive vs. HIV-negative (p = 0.001). CONCLUSIONS: Reduced glomerular filtration and/or proteinuria occurred in 15.5% of HIV-positive, and 3.6% of HIV-negative patients in this urban Malawian cohort. Since generalized renal monitoring is not feasible in Malawi or other resource-limited countries, strategies to identify patients at risk for higher stages of CKD and appropriate preventive measures are needed for both HIV-positive and HIV-negative patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0403-7) contains supplementary material, which is available to authorized users. BioMed Central 2016-11-22 /pmc/articles/PMC5118906/ /pubmed/27875991 http://dx.doi.org/10.1186/s12882-016-0403-7 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Glaser, Nicola
Phiri, Sam
Bruckner, Tom
Nsona, Dominic
Tweya, Hannock
Ahrenshop, Nomeda
Neuhann, Florian
The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title_full The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title_fullStr The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title_full_unstemmed The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title_short The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi
title_sort prevalence of renal impairment in individuals seeking hiv testing in urban malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118906/
https://www.ncbi.nlm.nih.gov/pubmed/27875991
http://dx.doi.org/10.1186/s12882-016-0403-7
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