Assessing renal impairment in treatment-naïve adolescents living with HIV commencing antiretroviral therapy in Zimbabwe

Byers, Bradley W.; Drak, Douglas; Shamu, Tinei; Chimbetete, Cleophas; Dahwa, Rumbi; Gracey, David

doi:10.1097/qad.0000000000003482

Cited by 3 publications

(7 citation statements)

References 37 publications

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“…Fourteen studies were cross-sectional (6, 33, 44–50, 52–57), with three nested within cohorts (6, 33, 51) and two were cohort studies (47, 51). Sample sizes ranged from 12-784 participants (median 237; interquartile range 123-371).…”

Section: Resultsmentioning

confidence: 99%

“…The most common biomarker used for CKD diagnosis was serum creatinine measured by the enzymatic method. Estimated GFR (eGFR) was used in 13 studies alone and in combination with markers of kidney damage (6, 33, 44–47, 51–53, 55–58). Five studies used an eGFR cut-off of <60ml/min/1.73m 2 (44–46, 55, 57), two used this cutoff alone without any marker of kidney damage (45, 57) and six used a cut-off of <90ml/min/1.73m 2 (6, 33, 47, 51, 53, 58).…”

Section: Resultsmentioning

confidence: 99%

“…KDIGO defines CKD as GFR<60ml/min/1.73m 2 with or without markers of kidney damage for three months or more (12) and this definition has been shown to improve diagnostic precision with implications for management (64). However, only four studies fulfilled the chronicity criteria; three studies repeated the tests after more than 3 months (47, 51, 55), and one study repeated the tests after only one month (49). Three studies used a cut-off of <90 ml/min/1.73m 2 which does not fit the KDIGO definition and tended to overestimate the CKD prevalence (6, 53, 54).…”

Section: Discussionmentioning

confidence: 99%

“…The studies reported information on 4,365 participants from 32 ART clinics in 14 SSA countries. Four studies were from West Africa (44)(45)(46)(47), five from East Africa (48)(49)(50)(51)(52), six from Southern Africa (6,33,(53)(54)(55)(56) and one from Central Africa (57). Eligible studies were conducted between 2013 and 2023.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The proportion of female participants in each study was 40-58%. Three studies recruited participants who were ART-naïve (46,47,58), 11 studies recruited ART-experienced participants (6,33,44,45,48,(51)(52)(53)(55)(56)(57), and two studies recruited both ART-naïve and ART-experienced participants (49,50). Three studies recruited only YPLHIV who were perinatally infected (6,33,51).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

Nasuuna,

Nanyenya,

Kibirige

et al. 2024

Preprint

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Background. Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA. Methods. We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPHLIV aged 10-24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Liard random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger’s test. Results. Of 802 retrieved articles, 16 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 13 (86.7%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only two studies followed the standard definition of CKD. The pooled CKD prevalence was 12.1% (95% CI 6.5-19.2%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2=97.5%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach. Conclusion. CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

Nasuuna,

Nanyenya,

Kibirige

et al. 2024

Preprint

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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

Nasuuna,

Tomlinson,

Kalyesubula

et al. 2024

BMC Nephrol

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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.

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Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

Nasuuna,

Nanyeenya,

Kibirige

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Background Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA. Methods We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPLHIV aged 10–24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Laird random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger’s test. Results Of 802 retrieved articles, 15 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 12 (80%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only one study followed the standard definition of CKD. The pooled CKD prevalence from 15 studies was 12% (95% CI 6.0–19.5%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2 = 97.7%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach. Conclusion CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management. Trial registration PROSPERO registration number: CRD42022347588.

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Assessing renal impairment in treatment-naïve adolescents living with HIV commencing antiretroviral therapy in Zimbabwe

Cited by 3 publications

References 37 publications

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

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

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

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