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Wudil UJ, Aliyu MH, Prigmore HL, Ingles DJ, Ahonkhai AA, Musa BM, Muhammad H, Sani MU, Nalado AM, Abdu A, Abdussalam K, Shepherd BE, Dankishiya FS, Burgner AM, Ikizler TA, Wyatt CM, Kopp JB, Kimmel PL, Winkler CA, Wester CW. Apolipoprotein-1 risk variants and associated kidney phenotypes in an adult HIV cohort in Nigeria. Kidney Int 2021; 100:146-154. [PMID: 33901548 PMCID: PMC8487768 DOI: 10.1016/j.kint.2021.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022]
Abstract
HIV-positive adults are at risk for various kidney diseases, and apolipoprotein 1 (APOL1) high-risk genotypes increase this risk. This study aimed to determine the prevalence and ethnic distribution of APOL1 risk genotypes among a cohort of HIV-positive Nigerian adults and explore the relationship between APOL1 risk variant status with albuminuria and estimated glomerular filtration rate (eGFR). We conducted a cross-sectional study among 2 458 persons living with HIV who attended an HIV clinic in northern Nigeria and had received antiretroviral therapy for a minimum of six months. We collected two urine samples four-eight weeks apart to measure albumin excretion, and blood samples to measure eGFR and determine APOL1 genotype. The frequency of APOL1 high-risk genotype was 6.2%, which varied by ethnic group: Hausa/Fulani (2.1%), Igbo (49.1%), and Yoruba (14.5%). The prevalence of microalbuminuria (urine/albumin creatinine ratio 30- 300 mg/g) was 37%, and prevalence of macroalbuminuria (urine/albumin creatinine ratio over 300 mg/g) was 3%. The odds of microalbuminuria and macroalbuminuria were higher for participants with the APOL1 high-risk genotype compared to those carrying the low-risk genotype ([adjusted odds ratio 1.97, 95% confidence interval 1.37-2.82] and [3.96, 1.95-8.02] respectively). APOL1 high-risk genotype participants were at higher risk of having both an eGFR under 60 ml/min/1.73m2 and urine/albumin creatinine ratio over 300 mg/g (5.56, 1.57-19.69). Thus, we found a high proportion of HIV-positive, antiretroviral therapy-experienced, and largely virologically suppressed adults had microalbuminuria. Hence, although the high-risk APOL1 genotype was less prevalent than expected, it was strongly associated with some level of albuminuria.
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Affiliation(s)
- Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather L Prigmore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aima A Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Baba M Musa
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria; Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Hamza Muhammad
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aisha M Nalado
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aliyu Abdu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kabiru Abdussalam
- Department of Chemical Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Anna M Burgner
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina M Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Paul L Kimmel
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - C William Wester
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Okpa HO, Bisong EM, Enang OE, Effa EE, Monjok E, Essien EJ. Predictors of chronic kidney disease among HIV-infected patients on highly active antiretroviral therapy at the University of Calabar Teaching Hospital, Calabar, South-South Nigeria. HIV AIDS (Auckl) 2019; 11:61-67. [PMID: 31118824 PMCID: PMC6501420 DOI: 10.2147/hiv.s189802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
Background: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 counts and associated with a high rate of morbidity and mortality. The objective of this study is to determine the prevalence and predictors of chronic kidney disease (CKD) amongst HIV patients on highly active antiretroviral therapy (HAART) at the University of Calabar Teaching Hospital, Calabar. Materials and methods: This was a cross-sectional study that was carried out over a 4-month period from May to August 2018. In all, a total of 118 patients with HIV on HAART were recruited into the study in a consecutive manner and their serum creatinine measured with the calculation of estimated glomerular filtration rate (eGFR). Other data collected were sex, age, weight, height, body mass index (BMI), waist hip ratio (WHR), packed cell volume, CD4 count etcetera. Data collected were inputted and analyzed with SPSS version 18, and statistical significance was taken to be p<0.05. Results: There were more females (69.5%) amongst the HIV participants and the prevalence of CKD was 15.3%. The risk factors seen to be associated with CKD were lower levels of CD4 count below 200 cells/µl, lower PCV, weight, BMI, and eGFR. Also, higher levels of WHR and creatinine were associated with CKD. Factors directly correlated with CKD were weight, BMI and CD4 count levels, while creatinine level was inversely correlated with CKD. However, a logistic regression model showed only creatinine to be a predictor of CKD. Conclusion: HIV patients on antiretroviral therapy, mainly the highly active antiretroviral therapy (HAART) have a relatively high prevalence of CKD of 15.3% and high level of serum creatinine was predictive of CKD in the logistic regression model in our study.
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Affiliation(s)
- Henry Ohem Okpa
- Renal Unit, Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Elvis Mbu Bisong
- Department of Family Medicine, University of Calabar, Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ofem Egbe Enang
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria.,Endocrine and Metabolism Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel Edet Effa
- Renal Unit, Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Emmanuel Monjok
- Department of Family Medicine, University of Calabar, Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria.,Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Ekere James Essien
- Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
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Ekrikpo UE, Kengne AP, Bello AK, Effa EE, Noubiap JJ, Salako BL, Rayner BL, Remuzzi G, Okpechi IG. Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis. PLoS One 2018; 13:e0195443. [PMID: 29659605 PMCID: PMC5901989 DOI: 10.1371/journal.pone.0195443] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/22/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients. METHODS We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman-Tukey transformation. RESULT Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2-7.7%) with MDRD, 4.8% (95%CI 2.9-7.1%) with CKD-EPI and 12.3% (95%CI 8.4-16.7%) with Cockcroft-Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2-11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9-20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0-3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status. CONCLUSION CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.
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Affiliation(s)
- Udeme E. Ekrikpo
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Renal Unit, Department of Medicine, University of Uyo, Uyo, Nigeria
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Emmanuel E. Effa
- Renal Unit, Department of Medicine, University of Calabar, Calabar, Nigeria
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Brian L. Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Bergamo, Italy
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Anyabolu EN, Chukwuonye II, Anyabolu AE, Enwere O. A look at risk factors of proteinuria in subjects without impaired renal filtration function in a general population in Owerri, Nigeria. Pan Afr Med J 2016; 23:257. [PMID: 27516822 PMCID: PMC4963176 DOI: 10.11604/pamj.2016.23.257.8189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction Proteinuria is a common marker of kidney damage. This study aimed at determining predictors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria. Methods This was a cross-sectional study involving 136 subjects, consecutively drawn from Federal Medical Centre (FMC), Owerri, Nigeria. Relevant investigations were performed, including 24-hour urine protein (24HUP). Correlation and multivariate linear regression analysis were used to determine the association and strength of variables to predict proteinuria. Proteinuria was defined as 24HUP ≥0.300g and impaired renal filtration function as creatinine clearance (ClCr) <90mls/min. P<0.05 was taken as statistically significant. Results Mean age of subjects was 38.58 ±11.79 years. Female/male ratio was 3:1. High 24-hour urine volume (24HUV) (p<0.001), high spot urine protein/creatinine ratio (SUPCR) (p<0.001), high 24-hour urine protein/creatinine ratio (24HUPCR) (p<0.001), high 24-hour urine protein/osmolality ratio (24HUPOR) (p<0.001), low 24-hour urine creatinine/osmolality ratio (24HUCOR) (p<0.001), and low spot urine protein/osmolality ratio (SUPOR) (p<0.001), predicted proteinuria in this study. Conclusion The risk factors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria, included 24HUV, SUPCR, 24HUPCR, 24HUPOR, 24HUCOR and SUPOR. Further research should explore the relationship between urine creatinine and urine osmolality, and how this relationship may affect progression of kidney damage, with or without impaired renal filtration function.
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Affiliation(s)
- Ernest Ndukaife Anyabolu
- Division of Nephrology, Department of Medicine, lmo State University Teaching Hospital, Orlu, Nigeria
| | | | - Arthur Ebelenna Anyabolu
- Division of Respirology, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Okezie Enwere
- Division of Nephrology, Department of Medicine, lmo State University Teaching Hospital, Orlu, Nigeria
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Anyabolu EN, Chukwuonye II, Arodiwe E, Ijoma CK, Ulasi I. Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria. Indian J Nephrol 2016; 26:10-5. [PMID: 26937072 PMCID: PMC4753735 DOI: 10.4103/0971-4065.156115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.
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Affiliation(s)
- E N Anyabolu
- Department of Medicine, Division of Nephrology, Federal Medical Centre, Owerri, Nigeria; Department of Medicine, Division of Nephrology, Imo State University Teaching Hospital, Orlu, Nigeria
| | - I I Chukwuonye
- Department of Medicine, Division of Nephrology, Federal Medical Centre, Owerri, Nigeria; Department of Medicine, Division of Nephrology, Federal Medical Centre, Umuahia, Nigeria
| | - E Arodiwe
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - C K Ijoma
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - I Ulasi
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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