Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study

Fabian, June; Kalyesubula, Robert; Mkandawire, Joseph; Hansen, Christian Holm; Nitsch, Dorothea; Musenge, Eustasius; Nakanga, Wisdom P; Prynn, Josephine E.; Dreyer, Gavin; Snyman, Tracy; Ssebunnya, Billy; Ramsay, Michèle; Smeeth, Liam; Tollman, Stephen; Naicker, Saraladevi; Crampin, Amelia C.; Newton, Robert; George, Jaya; Tomlinson, Laurie A.

doi:10.1016/s2214-109x(22)00239-x

Cited by 50 publications

(65 citation statements)

References 41 publications

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“…Normative ranges for GFR have not been established in African populations, including whether a cut-off of GFR of less than 60 mL/min/1.73 m 2 is an appropriate definition of CKD. 27 …”

Section: Discussionmentioning

confidence: 99%

“…This is nearer our estimate of AKD prevalence at 3 months, than our estimate of CKD. 27 A cross-sectional survey of urban and rural Malawi using the CKD-EPI equation suggested a prevalence of eGFR <60 mL/min/1.73 m 2 of 1%, and a systematic review of 13 countries in SSA estimated the pooled prevalence of CKD to be 14%. 28 29 …”

Section: Discussionmentioning

confidence: 99%

“…Estimating GFR using serum creatinine substantially underestimates the population level burden of impaired kidney function in Africa. 27 AKD assessment, which is broader and includes albuminuria and haematuria, may be more representative of the true burden. Regardless, we urgently need more accurate methods to report kidney disease for the region, or risk continued underreporting.…”

Section: Discussionmentioning

confidence: 99%

“…An assumed eGFR between 75 mL/min and 100 mL/min is supported by the median (IQR) iohexol measured GFR in Malawians reported in the ARK study: 86 mL/min/1.73 m 2 (72–100 mL/min/1.73 m 2 ) and 92 mL/min/1.73 m 2 (77–104 mL/min/1.73 m 2 ) for women and men, respectively. 27 …”

Section: Discussionmentioning

confidence: 99%

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Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi

Carey

Kaimba

Nyirenda³

et al. 2022

BMJ Open

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ObjectivesAcute kidney injury (AKI) is a common and severe complication of community acquired infection, but data on impact in sub-Saharan Africa (SSA) are lacking. We determined prevalence, risk factors and outcomes of infection associated kidney disease in adults in Malawi.DesignA prospective cohort study of adults admitted to hospital with infection, from February 2021 to June 2021, collecting demographic, clinical, laboratory and ultrasonography data.SettingAdults admitted to a regional hospital in Southern Region, Malawi.Primary and secondary outcome measuresThe primary outcomes were prevalence of kidney disease and mortality by Cox proportional hazard model. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes were risk factors for AKI identified by logistic regression and prevalence of chronic kidney disease at 3 months.ResultsWe recruited 101 patients presenting to hospital with infection. Median age was 38 years (IQR: 29–48 years), 88 had known HIV status of which 53 (60%) were living with HIV, and of these 42 (79%) were receiving antiretroviral therapy. AKI was present in 33/101 at baseline, of which 18/33 (55%) cases were severe (KDIGO stage 3). At 3 months, 28/94 (30%) participants had died, while 7/61 (11%) of survivors had chronic kidney disease. AKI was associated with older age (age: 60 years vs 40 years, OR: 3.88, 95% CI 1.82 to 16.64), and HIV positivity (OR: 4.08, 95% CI 1.28 to 15.67). Living with HIV was independently associated with death (HR: 3.97, 95% CI 1.07 to 14.69).ConclusionsKidney disease is common among hospitalised adults with infection in Malawi, with significant kidney impairment identified at 3 months. Our study highlights the difficulty in diagnosing acute and chronic kidney disease, and the need for more accurate methods than creatinine based estimated glomerular filtration rate (eGFR) equations for populations in Africa. Patients with kidney impairment identified in hospital should be prioritised for follow-up.

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“…Normative ranges for GFR have not been established in African populations, including whether a cut-off of GFR of less than 60 mL/min/1.73 m 2 is an appropriate definition of CKD. 27 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi

Carey

Kaimba

Nyirenda³

et al. 2022

BMJ Open

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“…2 Investigators have sought to improve the accuracy of eGFR formulae by eliminating race and using additional markers of kidney function such as cystatin C. 3 However, before this outcry in North America, studies in Africa had already drawn attention to the fact that these eGFR formulae overestimated GFR and underestimated the prevalence of kidney disease in African populations. 4,5 These facts underscore the importance of the study in The Lancet Global Health by June Fabian and colleagues, 6 which aimed to evaluate the most reliable method to estimate kidney function in sub-Saharan Africa, as a prerequisite to determining the true burden of chronic kidney disease (CKD) in Africa. The investigators compared the accuracy of ten eGFR formulae, based on serum creatinine and cystatin C, with measured GFR (mGFR) using iohexol clearance, in 2578 adults from Malawi, Uganda, and South Africa.…”

mentioning

confidence: 99%

Measuring kidney function: the voice of Africa

Niang

Luyckx

2022

The Lancet Global Health

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Blood pressure increases are associated with weight gain and not antiretroviral regimen or kidney function: a secondary analysis from the ADVANCE trial in South Africa

Manne‐Goehler,

Fabian,

Sokhela

et al. 2024

J Int AIDS Soc.

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IntroductionRecent evidence has raised questions about whether newer HIV treatment regimens, including dolutegravir (DTG) and tenofovir alafenamide (TAF), are associated with increases in blood pressure (BP).MethodsWe assessed changes in BP by treatment regimen and evaluated the relative contribution of kidney function and weight gain to these changes among participants in the ADVANCE phase‐3 trial clinical trial in South Africa (study dates: January 2017–February 2022). Our primary outcome of interest was a change in systolic BP (SBP) at 96 and 192 weeks, among those not receiving antihypertensive medication. The secondary outcome was treatment‐emergent hypertension at these same time points, defined as BP ≥140/90 mmHg on two occasions, or initiation of antihypertensive medication after week 4 among individuals without hypertension at enrolment. We used linear regression to evaluate the relationship between change in estimated glomerular filtration rate (eGFR) and change in SBP; and Poisson regression to evaluate the relationship between change in eGFR and treatment‐emergent hypertension at each time point. All models were adjusted for age, sex, treatment group and change in body mass index (BMI).ResultsOver 96 weeks, the average changes in SBP were 1.7 mmHg (95% CI: 0.0−3.4), −0.5 mmHg (95% CI: −2.2 to 1.7) and −2.1 mmHg (95% CI: −3.8 to 0.4) in the TAF/emtricitabine (FTC)/DTG, tenofovir disoproxil fumarate (TDF)/FTC/DTG and TDF/FTC/efavirenz (EFV) groups, respectively. This difference was significant for the TAF/FTC/DTG compared to the TDF/FTC/EFV group (p = 0.002). Over 96 weeks, 18.2% (95% CI: 13.4–22.9), 15.4% (95% CI: 11.0–19.9) and 13.3% (95% CI: 8.9–17.6) of participants developed treatment‐emergent hypertension, respectively. In adjusted models, there was no significant relationship between change in eGFR and either outcome. Change in BMI was significantly associated with an increase in SBP, while age was associated with an increased risk of treatment‐emergent hypertension. Adjustment for BMI also mitigated the unadjusted relationship between HIV treatment regimen and SBP where present.ConclusionsIn the ADVANCE cohort, weight gain and age accounted for increases in BP and risk of treatment‐emergent hypertension. HIV treatment programmes may need to integrate the management of obesity and hypertension into routine care.Clinical Trial NumberNCT03122262

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Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study

Cited by 50 publications

References 41 publications

Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi

Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi

Measuring kidney function: the voice of Africa

Blood pressure increases are associated with weight gain and not antiretroviral regimen or kidney function: a secondary analysis from the ADVANCE trial in South Africa

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