Morbidity and mortality of black HIV-positive patients with end-stage kidney disease receiving chronic haemodialysis in South Africa

Fabian, June; Maher, Heather; Clark, C. J.; Naicker, Saraladevi; Becker, Piet J.; Venter, François

doi:10.7196/samj.8369

Cited by 8 publications

(16 citation statements)

References 16 publications

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“…A total of 6758 studies were excluded as they did not meet the inclusion criteria for this study. Of those, 10 underwent a full manuscript review and were found to have no valuable data for analysis in this study for the following reasons: not within the specified time frame [ 12 , 17 , 20 – 23 ], outcomes of chronic haemodialysis [ 24 ], systematic review and meta-analyses of countries in Sub-Saharan Africa (9), irrelevant study population [ 25 ], and a dissertation published at a later stage [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

et al. 2017

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BackgroundIt is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell count.MethodsWe searched Google Scholar, PubMed, Medline, Cochrane Library, Worldcat.org and EBSCO host databases from July 2015 to December 2015. Eligibility criteria included articles pertaining to renal manifestations of HIV in South Africa from 2004 to 2015 in adult patients (≥ 18 years). We independently reviewed the articles for quality. Thematic content analysis was performed to identify patterns of renal manifestations from the included studies. The risk of bias (e.g. internal validity) in the included studies was evaluated using the mixed methods appraisal tool.ResultsEleven out 21 studies were eligible for data extraction. The prevalence of urine abnormalities on urine dipsticks was high but had poor sensitivity and specificity for detecting renal impairment. Normal renal function occurred in 28.4 to 79% of patients, mild renal impairment occurred in 19 to 57.1% and moderate renal impairment in 2 to 14.4%. Severe renal impairment occurred in 1.3% of patients. Both the Cockcroft-Gault equation (after correcting for bias) and the 4-variable Modification of Diet in Renal Disease equation (without the ethnicity factor for African Americans) have been validated for the estimation of glomerular filtration rate (eGFR) in Black South Africans. HIV-associated nephropathy was the most prevalent histology seen (57.2%). Older age, a lower CD4 count, a low haemoglobin and a detectable viral load were associated with renal impairment. Renal function improved in the first year of commencing ART as evidenced by the regression of proteinuria and the increase in eGFR.ConclusionThe findings of the review have implications to the recently adopted ‘test and treat’ approach to HIV prevention and management.Systematic review registrationPROSPERO CRD42016039270 Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0605-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

et al. 2017

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“…The number of people living with HIV/AIDS has steadily increase, with greatest prevalence and mortality rate in SSA [ 1 ]. In Cameroon HIV and ESKD are public health problem, and ESKD due to HIV remain a serious concern [ 18 – 21 ]. Combined ART is freely available since 2007.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the burden of HIV and the improve access to RRT and c-ART in most countries in sub Saharan Africa (SSA), data on survival of HIV patients on RRT are rare. A recent study in South Africa reported a similar survival between HIV positive and negative patients [ 18 ].…”

Section: Introductionmentioning

confidence: 92%

Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study

et al. 2018

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BackgroundThere are conflicting reports on the impact of HIV in the era of combined antiretroviral (c-ART) on survival of patient with ESKD. We aimed to compare the one-year survival of HIV positive patients to that of their HIV negative counterparts with ESKD on maintenance haemodialysis in Cameroon.MethodsThis was a retrospective cohort study conducted in the haemodialysis units of the Douala and Yaoundé General Hospitals. All HIV positive patients treated by maintenance haemodialysis between January 2007 and March 2015 were included. A comparative group of HIV negative patients with ESKD were matched for age, sex, co morbidities, year of dialysis initiation and haemodialysis unit. Relevant data at the time of haemodialysis initiation and during the first year of haemodialysis was noted. Survival was analysed using the Kaplan Meier and Cox regression hazard ratio estimator. A p value < 0.05 was considered statistically significant.ResultsA total of 57 patients with HIV and 57 without HIV were included. Mean age was 46.25 ± 11.41 years, and 52.6% were females in both groups. HIV nephropathy (50.9%) was the main presumed aetiology of ESKD in the HIV group, while chronic glomerulonephritis (33.3%) and diabetes (21.1%) were the main aetiologies in the HIV negative group. At initiation of dialysis, the median CD4 count was 212 cell/mm3 (IQR; 138–455) and 77.2% were receiving c-ART. The proportion of patients who initiated dialysis with a temporary venous catheter was similar in both groups (p = 0.06). After one year on haemodialysis, survival rate was lower in the HIV positive group compared to the HIV negative group (61.4%/78.9%, HR: 2.05; 95% CI: 1.03–4.08; p = 0.042).Kaplan Meier survival curve was in direction of a lower survival in HIV positive group (p = 0.052).ConclusionThe one year survival of HIV positive patients on maintenance haemodialysis in Cameroon seems to be lower compared to their HIV negative counterparts.

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“…2 There is evidence which suggests that South African HIV-positive patients are reluctant to participate in non-surgical clinical research studies. 3 This reluctance to participate might also extend to surgical clinical research studies. Participation of HIV-positive surgical patients in research is necessary if this group is to reap the benefits of clinical trials and future advances in surgical science.…”

Section: Introductionmentioning

confidence: 99%

General attitudes toward research: a pilot survey of HIV-positive surgical patients

Moodley

Madiba

2019

S. Afr. j. surg.

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The study sample consisted of 39 consecutive adult (≥ 18 years old) HIV-positive colorectal surgery patients who attended IALCH between 01 October 2016 and 31 March 2017. HIV status was determined from laboratory reports or admission notes in the patients' medical records. An additional inclusion criterion for this study was that all study participants were required to provide written informed consent and comply with the study procedures (ie. completion of the survey questionnaire). Furthermore, individual study participants were only allowed a single opportunity to complete the survey questionnaire (ie. multiple attempts at completing the survey questionnaire by the same patient were excluded). General attitudes toward research: a pilot survey of HIV-positive surgical patients

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Morbidity and mortality of black HIV-positive patients with end-stage kidney disease receiving chronic haemodialysis in South Africa

Cited by 8 publications

References 16 publications

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study

General attitudes toward research: a pilot survey of HIV-positive surgical patients

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