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Comorbidities associated with chronic kidney disease among young people living with HIV in Uganda. A nested case
Insights
Young people living with HIV (YPLHIV) with chronic kidney disease (CKD) face unique comorbidities. Detectable HIV viral load and proteinuria are linked to CKD in this population.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Chronic kidney disease (CKD) presents significant mortality and morbidity risks, particularly in individuals with co-occurring conditions.
- Young people living with HIV (YPLHIV) are susceptible to multisystem chronic comorbidities, yet data on CKD-associated comorbidities are scarce.
Purpose of the Study:
- To investigate the comorbidities associated with chronic kidney disease (CKD) in young people living with HIV (YPLHIV).
- To identify clinical factors linked to CKD development in this vulnerable population.
Main Methods:
- A case-control study was conducted in Kampala, Uganda, involving 96 YPLHIV with CKD (cases) and 196 YPLHIV without CKD (controls).
- Data collected included demographic factors, blood pressure, glucose levels, haematological parameters, and viral load. Logistic regression was used to determine associations.
Main Results:
- CKD in YPLHIV was significantly associated with detectable HIV viral load (OR=3.73) and proteinuria (aOR=4.19).
- Associated laboratory findings included low haematocrit, hypochloraemia, hyperphosphatemia, and high mean corpuscular volume.
- No association was found between CKD and hypertension, anemia, or stunting in this cohort.
Conclusions:
- The comorbidity profile of CKD in YPLHIV remains unclear, potentially complicated by challenges in assessing kidney function in this group.
- Further research is essential to elucidate CKD complications in YPLHIV for improved management and outcomes.
Introduction:
Chronic kidney disease (CKD) is often complicated by disorders in multiple body systems, associated with higher mortality and morbidity. Young people living with HIV (YPLHIV) have an increased risk of multisystem chronic comorbidities. However, there are few data describing comorbidities associated with CKD among YPLHIV.
Methods:
We conducted a case-control study in seven ART clinics in Kampala, Uganda. Cases were YPLHIV (aged 10-24 years) diagnosed with CKD and controls were those without CKD. We collected data on demographic and clinical factors: blood pressure, fasting glucose levels, anaemia, electrolytes, parathyroid hormone, and cognitive impairment. We summarized the demographic and clinical factors and used logistic regression to estimate odds ratios (OR) and 95% confidence intervals for associations between CKD comorbidities, adjusted for age, sex and viral suppression.
Results:
A total of 292 participants (96 cases and 196 controls) were recruited. Cases were mostly male (59.4% vs 36.5%), and younger (88.5% vs 46.4% aged <17 years) compared to controls. CKD was associated with having a detectable HIV viral load (OR=3.73; 95% CI 1.53-9.12) and proteinuria (aOR=4.19; 95% CI 2.28-7.72). CKD was also associated with low haematocrit, hypochloraemia, hyperphosphatemia, and high mean corpuscular volume. There was no evidence of an association of CKD with hypertension, anaemia, or stunting.
Conclusion:
The pattern of comorbidities among YPLHIV with CKD is uncertain and difficulties may relate to difficulty determining true kidney function and normal ranges in this population. Further studies are needed to discern the pattern of CKD complications to improve management efforts and clinical outcomes.
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