No abstract

The human immunodeficiency virus (HIV) pandemic is one of the leading causes of death in the developing world. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with HIV are major causes of morbidity and mortality in HIV-positive patients. This cross-sectional study was conducted to determine the prevalence and risk factors of CKD in HIV-positive, antiretroviral naïve patients at a single HIV clinic in Lagos, Nigeria. Of 402 patients, CKD was observed in 23.5% while among 146 controls, CKD was detected in 5.5% (odds ratio (OR) 5.34 [95% CI 2.4-12.2]; P<0.0001). Macroalbuminuria was seen in 20.1% of patients and 2.1% of controls, (OR 12 [95% CI 3.7-38.5]; P<0.0001). Most of the patients and controls were categorized into CKD stages 1 and 2, none among the control was in stage 4 or 5 CKD, while 2 and 2.2% of patients were in stages 4 and 5, respectively (P=0.005). Macroalbuminuria (P<0.0001) and HIV RNA viral load (P=0.010) correlated with CKD on multivariate linear regression analysis. Macroalbuminuria may, therefore, be a useful marker of degree of CKD in HIV seropositive patients. To reduce the burden of CKD and ESRD in populations with high prevalence of HIV, there is a need for increased screening and surveillance for CKD through performance of simple tests to estimate protein in the urine. One of the limitations of this is in using the abbreviated Modification of Diets in Renal Disease (MDRD) equation for estimating glomerular filtration rate

Screening of individuals at increased risk of developing chronic kidney disease (CKD) has been advocated by several guidelines. Among individuals at increased risk are first-degree relatives (FDRs) of patients with CKD. There is a paucity of data on the prevalence and risk of CKD in FDRs of patients with CKD in sub-Saharan African population. This study aimed to screen FDRs of patients with CKD for albuminuria and reduced estimated glomerular filtration rate (eGFR). A cross-sectional survey of 230 FDRs of patients with CKD and 230 individuals without family history of CKD was conducted. Urinary albumin: creatinine ratio (ACR) was determined from an early morning spot urine. Glomerular filtration rate was estimated from serum creatinine. Reduced eGFR was defined as eGFR <60 ml/min/1.73 m2 and albuminuria defined as ACR ≥30 mg/g. A higher prevalence of albuminuria was found in the FDRs compared to the controls (37.0% vs. 22.2%; P < 0.01). Reduced eGFR was more prevalent among the FDRs compared with the controls (5.7% vs. 1.7%, P < 0.03). Hypertension (odds ratio [OR], 2.9) and reduced eGFR (OR, 9.1) were independent predictors of albuminuria while increasing age (OR, 6.7) and proteinuria (OR, 10.7) predicted reduced eGFR in FDRs. The odds of developing renal dysfunction were increased 2-fold in the FDRs of patients with CKD, OR 2.3, 95% confidence interval, 1.29–3.17. We concluded that albuminuria and reduced eGFR are more prevalent among the FDRs of patient with CKD and they are twice as likely to develop kidney dysfunction as healthy controls.

BackgroundIntravenous low molecular weight iron dextran and iron sucrose have been used for correction of iron deficiency for many years and have been shown to improve anaemia in chronic kidney disease (CKD). However, there is a paucity of head to head comparisons of these parenteral iron preparations. Such comparative efficacy data would be of particular interest in resource-limited African countries, where the majority of CKD patients are unable to afford erythropoiesis-stimulating agents. Therefore, the aim of this study was to compare the effects of these two intravenous iron preparations in pre-dialysis CKD patients.MethodsSixty-seven anaemic pre-dialysis CKD patients were randomized to one of two treatment groups. The low molecular weight iron dextran group (n = 33) received 1000 mg of low molecular weight iron dextran intravenously in four divided doses of 250 mg. The iron sucrose group (n = 34) received 1000 mg of iron sucrose intravenously in five divided doses of 200 mg. Complete blood count, serum creatinine, serum iron, unsaturated iron binding capacity, serum ferritin and transferrin saturation were assessed at baseline. The baseline parameters were repeated in all patients on Day 24. The primary outcome was the proportion of patients achieving a rise in haemoglobin (Hb) concentration of ≥1.0 g/dL after iron therapy.ResultsThere was no significant difference in the proportion of patients achieving the primary end point between both arms of the study: [7 (21.9%) low molecular weight iron dextran versus 11 (32.4%) iron sucrose; relative risk 0.68, 95% confidence interval (CI): 0.19–1.70; P = 0.23]. At Day 24, the mean increase in Hb concentration from baseline was comparable between the two groups: low molecular weight iron dextran 0.4 ± 0.7 g/dL versus iron sucrose 0.6 ± 0.9 g/dL, mean difference 0.2 g/dL (95% CI: −0.26–0.61; P = 0.28). The proportion of patients that experienced at least one or more adverse events was 27.3% in the iron dextran group versus 14.7% in the iron sucrose arm (P = 0.21).ConclusionBoth intravenous low molecular weight iron dextran and intravenous iron sucrose are effective in correcting iron deficiency and anaemia in pre-dialysis CKD patients.