Abstract
BackgroundChronic 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.MethodsThis 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.ResultsOut 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 m2 accompanied by proteinuria with results as 11.2% vs. 1.2%, respectively for clients who were HIV-positive vs. HIV-negative (p = 0.001).ConclusionsReduced 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 materialThe online version of this article (doi:10.1186/s12882-016-0403-7) contains supplementary material, which is available to authorized users.
Highlights
Chronic kidney disease (CKD) poses a major health threat to people living in low- and middle-income countries, especially when it is combined with Human immunodeficiency virus (HIV), antiretroviral treatment (ART) or communicable and noncommunicable diseases
noncommunicable disease (NCD) account for 60% of all deaths worldwide, and 80% occur in low- and middle-income countries (LMIC) [1, 2], which underlines the assumption that NCDs are associated with poverty [3]
The consequences of CKD are hypothesized to be worse in LMIC because of the high burden of non-communicable and communicable diseases, such as HIV infection and tuberculosis as well as infectious tropical diseases coupled with limited access to health care facilities for routine screening [5,6,7]
Summary
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 noncommunicable diseases. Data about the prevalence of CKD and its association with other diseases is scarce, 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. NCDs account for 60% of all deaths worldwide, and 80% occur in low- and middle-income countries (LMIC) [1, 2], which underlines the assumption that NCDs are associated with poverty [3]. CKD occurs more frequently in patients with hypertension, cardiovascular disorders or diabetes [4]. Calculations suggest that approximately 200–300 individuals per million are affected by CKD in sub-Saharan Africa (SSA) [8]
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