Validation of the D:A:D chronic kidney disease risk score in people living with HIV: the IeDEA West Africa Cohort Collaboration

Abstract

ObjectivesA risk score for long‐term prediction of chronic kidney disease (CKD) in people living with HIV (PLHIV) has been developed using data from the D:A:D cohort. We assessed the performance of the D:A:D risk score in a cohort of PLHIV in West Africa.MethodsData from PLHIV starting antiretroviral treatment in four clinics in Burkina Faso, Côte d’Ivoire and Togo participating in the IeDEA West Africa collaboration were analysed. CKD was defined as two consecutive estimated glomerular filtration rates (eGFRs) of ≤ 60 mL/min/1.73 m2. The D:A:D score (short version) was calculated using age, gender, nadir CD4 and baseline eGFR and was categorized into low, medium, and high‐risk groups.ResultsIn 14 930 participants (70% female, median age = 38 years; median nadir CD4 count = 183 cells/µL) followed for a median duration of 5.7 years, 660 (4.4%) progressed to CKD, with an incidence [95% confidence interval (CI)] of 7.8 (7.2–8.4) per 1000 person‐years (PY). CKD incidence rates were 2.4 (2.0–2.8), 8.1 (6.8–9.6) and, 30.9 (28.0–34.1) per 1000 PY in the low‐, medium‐ and high‐risk groups, respectively. In the high‐risk group, 14.7% (95% CI: 13.3; 16.3) had progressed to CKD at 5 years. Discrimination was good [C‐statistics = 0.81 (0.79–0.83)]. In all, 79.4% of people who progressed to CKD were classified in the medium‐ to high‐risk group at baseline (sensitivity) and 66.5% of people classified in the low risk group at baseline did not progress to CKD (specificity).ConclusionsThese findings confirm the validity of the D:A:D score in identifying individuals at risk of developing CKD who could benefit from enhanced kidney monitoring in West African HIV clinics.

APOL1 Renal Risk Variants and Kidney Function in HIV-1–Infected People From Sub-Saharan Africa

“…Indeed, no case of CKD was J o u r n a l P r e -p r o o f recorded in HR genotype carriers in the 2LADY cohort and only one case was recorded in this group in DCU cohort. Yet, the incidence of CKD in the DCU and 2LADY cohorts (5.7 and 10.3 per 1000 person-year, respectively) were consistent with previous studies investigating kidney function among PLHIV in different countries of West Africa 42 .…”

“…Yet, the incidence of CKD in the DCU and 2LADY cohorts (5.7 and 10.3 per 1000 person-years, respectively) was consistent with previous studies investigating kidney function among PLHIV in different countries of West Africa. 42 …”

Brief Report: Validation of the D:A:D Chronic Kidney Disease Risk Score Incorporating Proteinuria in People Living With HIV in Harare, Zimbabwe

“…The proportion in our cohort with diabetes was 2.3%, while reported prevalence in Zimbabwe ranges from 1.5% to 5.7%, with 66.1% of cases estimated to be undiagnosed. 25,26 The only other validation study from sub-Saharan Africa 15 did not evaluate diabetes or hypertension as risk variables. Despite the well-established association of APOL1 risk alleles and CKD in Black Africans, 27 our resource-limited setting meant we did not have access to genotyping for our cohort and were thus unable to determine the influence of these risk alleles.…”

“…The long version also included hypertension, diabetes, and cardiovascular events. We developed a “modified” D:A:D risk score more applicable to sub-Saharan African populations, similar to Poda et al 15 This removed hepatitis C and intravenous drug use (IVDU) as risk variables and included hypertension and diabetes (identified as documented diagnoses in the electronic medical records), given their independent association with CKD in PLWH. 16,17…”

“…The long version also included hypertension, diabetes, and cardiovascular events. We developed a "modified" D:A:D risk score more applicable to sub-Saharan African populations, similar to Poda et al 15 This removed hepatitis C and intravenous drug use (IVDU) as risk variables and included hypertension and diabetes (identified as documented diagnoses in the electronic medical records), given their independent association with CKD in PLWH. 16,17 Proteinuria was not included in Mocroft's D:A:D risk score because of lack of data in the original study cohort; however, given its established association with progression of CKD in HIV-infected patients, 18,19 we included it as an additional variable in a nested model to evaluate whether it improved ability to predict CKD.…”