Table 3.
Studies on CKD among patients with HIV
| Author | Year, country, region | Location | N | Study group | Population characteristics | Definition of CKD | Methods of outcome assessment | Creatinine assay | Proteinuria | CKD prevalence | Quality assessment |
| Wkba142 | 2013, Ghana, West | ART clinic at the regional hospital | 442 | HIV (276 HAART-naïve patients 166 on HAART) |
Age (years): HAART-naïve (33.42±0.88), on HAART (36.91±0.77) Male gender: HAART-naïve (28.3%), on HAART (22.3%) |
eGFR <60 mL/min/1.73 m2 for >3 months | CG, 186 MDRD, CKD-EPI | Kinetic Jaffe | Not measured | Total prevalence (CKD-EPI): 10.2% HAART-naïve: 8.7% CG, 9.1% MDRD, 8.7% CKD-EPI On HAART: 14.5% CG, 12.6% MDRD, 12.6% CKD-EPI Prevalence by gender Female: HAART-naïve (7.5%), HAART (14%) Male: HAART-naïve (11.5%), HAART (8.1%) |
Low |
| Stöhr143 | 2011, Uganda, Zimbabwe, East and South | Three centres in Uganda and Zimbabwe | 3316 | HIV-infected patients initiating ART | Age (years): 36.8 (32–42.2) Male gender: 35% SBP: median: 110 (IQR: 100–120) mm Hg DBP: median: 70 (60–80) mm Hg BMI: 21.1 (19.1–23.6) kg/m2 |
eGFR <60 mL/min/1.73 m2 on ≥2 consecutive visits 80 days apart or confirmed 25% decrease if eGFR <60 mL/min/1.73 m2 at baseline | CG | Kinetic Jaffe | Not measured | Total prevalence: 7.2% | Medium |
| Stöhr144 | 2008, Uganda, Zimbabwe, East and South | Three centres in Uganda and Zimbabwe | 3316 | HIV-infected patients on ART | Age (years): 36.8 (32–42.2) Male gender: 35% SBP: median: 110 (IQR: 100–120) mm Hg DBP: median: 70 (60–80) mm Hg BMI categories <18.5 kg/m2: 18% 18.5 to <25 kg/m2: 66% 25 to <30 kg/m2: 12% ≥30 kg/m2: 4% |
eGFR <60 mL/min 1.73 m2 on ≥2 consecutive occasions >80 days apart or confirmed 25% decrease if eGFR <60 mL/min/1.73 m2 at baseline | 186 MDRD, CG | Kinetic Jaffe | Not measured | Total prevalence (MDRD): 3.1% CG: 7.4% |
Medium |
| Cailhol79 | 2011, Burundi, East | Outpatients HIV clinic | 300 | HIV-infected patients | Age (years): 40.1 (33–46.5) Male gender: 29.7% Hypertension: 2.7% DM: 2% BMI: median: 21.8 (19.3–24.2) kg/m2 |
KDOQI | Proteinuria by urinary strip, CG, 186 MDRD | Not mentioned | 6.10% | Total prevalence (MDRD): 45.7% CG: 46.5% Prevalence by stages (using MDRD) Stage 1: 30.2% Stage 2: 13.5% Stage 3: 2% Stages 4 and 5: no patients |
Medium |
| Masimango107 | 2014, Congo, Central | Outpatient HIV clinic | 235 | HIV-infected patients | Age (years): 40.0±10.7 Male gender: 27.8% Hypertension: 46.8% DM: 1.7% BMI: 22.3±3.8 kg/m2 |
Proteinuria ≥+1 by urinary strip or albuminuria ≥30 mg/dL | Proteinuria by urinary strip and ACR | Not measured | Proteinuria ≥+1: 41.3% | Total prevalence (based on proteinuria): 41.3% | Low |
| Reid145 | 2008, Uganda, Zimbabwe, East and South | Three centres in Uganda and Zimbabwe | 3316 | HIV-infected, ART-naïve adults with CD4+ cell counts of <200 cells/mm3 | Age (years): 36.8 (IQR: 32.0–42.2) Male gender: 35% SBP: median: 110 (IQR: 100–120) mm Hg DBP: median: 70 (IQR: 60–80) mm Hg BMI: median: 21.1 (IQR: 19.1–23.6) kg/m2 |
eGFR <60 mL/min 1.73 m2 on ≥2 consecutive occasions >80 days apart or confirmed 25% decrease if eGFR <60 mL/min/1.73 m2 at baseline | CG | Kinetic Jaffe | Not measured | Total prevalence: 7% | Medium |
| Fabian108 | 2009, South Africa, South | HIV outpatient clinic at Johannesburg Hospital | 578 | HIV-infected naïve ART patients | Age (years): 37 (range 16–70 years) Male gender: 38% DM: 4.6% among group with microalbuminuria |
Proteinuria ≥+1 by urinary strip or albuminuria ≥30 mg/dL | Proteinuria by urinary strip and PCR | Not measured | 43.7% had proteinuria | Total prevalence (based on proteinuria prevalence): 43.7% | Low |
| Lucas154 | 2010, Uganda, East | All consenting individuals residing in every household in 50 Rakai District communities | 1960 | 1202 HIV-infected patients and 664 HIV-negative age-matched and sex-matched controls | Age (years): HIV-negative: 28 (IQR: 24–35); HIV-positive: 30 (IQR: 25–36) Male gender: HIV-negative: 38.7%; HIV-positive: 36.4% |
eGFR <60 mL/min/1.73 m2 | MDRD | IDMS-calibrated | Not measured | Total prevalence among HIV-positive: 0.7% | Medium |
| Jao160 | 2011, sub-Saharan | Primary healthcare units | 2495 | HIV-infected patients before ART | Age (years): 30 (IQR: 27–35) Male gender: 30% BMI: 22.8 (IQR: 20.4–25.6) kg/m2 |
CrCl <50 mL/min | CG, 186 MDRD, CKD-EPI | Not mentioned | Not measured | Total prevalence (CKD-EPI with coefficient for black race): 2.5% CG: 3.4% (MDRD with coefficient for black race): 2.5% Prevalence by age <30 years: 29.8% 30–39 years: 57.1% ≥40 years: 13.1% Prevalence by gender Female: 66.7% |
Medium |
| Longo99 | 2012, Congo, Central | Consecutive patients with HIV from clinic | 300 | HIV-infected (ART treated=264) (ART-naïve=36) |
Age (years): 43±9 Male gender: 23% Hypertension: 13% BMI: 24±5 kg/m2 |
eGFR <60 mL/min/1.73 m2 or proteinuria defined as 1+ or greater | Proteinuria by dipstick and 24-hour proteinuria, eGFR by MDRD, CG | Kinetic Jaffe and IDMS | 20.50% | Total prevalence: 20.5% 3% of the patients had eGFR <60 mL/min/1.73 m2 by MDRD |
Low |
| Sarfo109 | 2013, Ghana, West | HIV clinic | 3137 | HIV-infected patients starting ART | Age (years): 38 (32–45) Male gender: 33% BMI: 20.3 (IQR: 17.6–22.7) kg/m2 |
eGFR <60 mL/min/1.73 m2, or proteinuria ≥+1 (confirmed by uPCR >45 mg/mmol) | Proteinuria by urinary strip, ACR, PCR, eGFR by CG, MDRD, CKD-EPI | Not mentioned | Total prevalence (CKD-EPI): 13.8% | Low | |
| Gupta161 | 2011, Cameroon, Central-West | Electronic medical records of patients from 18 sites throughout Western Kenya | 7383 | Patients with HIV without ART | Age (years): 35.5 (29.3–44.0) Male gender: 26.9% |
eGFR <60 mL/min/1.73 m2 | CG, MDRD | Not mentioned | Total prevalence (MDRD): 9.4% CG: 20.2% Prevalence by gender Female: 79.1% |
Medium | |
| Ekat146 | 2013, Congo, Central | Ambulatory treatment centre | 562 | Newly diagnosed patients with HIV | Age (years): 38.84 (IQR: 33.18–46.23) Male gender: 33.9% BMI: 20.31 (IQR: 17.97–22.89) kg/m2 |
eGFR <60 mL/min/1.73 m2 | 186 MDRD | Kinetic Jaffe | Not measured | Total prevalence: 8.5% | Low |
| Wools-Kaloustian80 | 2007, Kenya, East | Academic Model for the Prevention and Treatment of HIV/AIDS clinic |
373 | HIV-infected patients naïve to ART | Age (years): 35.0 (range, 19–60) Male gender: 32.1% SBP: 104.7 (range, 80–140) mm/Hg |
CrCl <60 mL/min/1.73 m2 | Proteinuria by urinary strip, CG, full and abbreviated MDRD | Kinetic assay | 6.2% (proteinuria ≥1+) | Total prevalence: 11.50% | Low |
| Emem81 | 2008, Nigeria, West | HIV/AIDS outpatient clinic | 400 | HIV-infected patients | Age (years): 34.6±9.4 Male gender: 48.5% Hypertension: 13.2% BMI categories <19.0 kg/m2: 59.2% 19–25 kg/m2: 37.5% >25 kg/m2: 3.3% |
Albuminuria +1 on at least two occasions (4 weeks apart) and/or serum creatinine >1.5 mg/dL | Proteinuria or albuminuria by urinary strip and 24-hour proteinuria, CG | Not mentioned | 38% proteinuria with dipstick 21.9% nephrotic range proteinuria |
Total prevalence : 38.8% Among patients, 8.8% had CrCl <15 mL/min. |
Medium |
| Wyatt82 | 2011, Rwanda, East | Community-based | 891 | 677 HIV-infected and 214 HIV-uninfected | Age (years): 34 (IQR: 30–39) HIV-positive: 43 (IQR: 34–50), HIV-negative Male gender: 0 Hypertension: HIV-positive: 4.8%/HIV-negative: 8.3% BMI (kg/m2): HIV-positive: 20.9 (IQR: 19.0–23.3)/HIV-negative: 20.5 (IQR: 18.5–23.3) |
eGFR <60 mL/min/1.73 m2 or proteinuria +1 or greater | Proteinuria by urinary strip, eGFR by MDRD, CKD-EPI, CG | Kinetic Jaffe | (9% among HIV-positive and 7.2% among non-infected) | Total prevalence among HIV-positive: 9% 2.7% had eGFR <60 mL/min/1.73 m2 CKD prevalence among HIV-negative: 7.2% 1.5% had eGFR <60 mL/min/1.73 m2 |
Medium |
| FolefackKaze83 | 2013, Cameroon, Central-West | HIV clinic of Yaoundé General Hospital | 104 | All newly diagnosed HIV-infected patients naïve to HAART | Age (years): 35±10.7 Male gender: 32% |
Presence of proteinuria +1 or more and eGFR <60 mL/min based on the average of eGFR by two equations | Proteinuria by urinary strip, eGFR by CG, 175 MDRD | Kinetic Jaffe | 36% | Total prevalence: 36% Among patients, 3% had eGFR<60 mL/min/1.73 m2. |
Low |
| Struik84 | 2011, Malawi, East | ART clinic in a central hospital in Malawi | 526 | Consecutive newly referred HIV-infected patients on ART | Age (years): 34.3±9.3 Male gender: 43.5% Hypertension: 11.2% DM: 0.8% |
Any proteinuria (≥+1), heavy proteinuria (≥+2), any proteinuria (≥+1) with renal dysfunction (eGFR <60 mL/min/1.73 m2), and heavy proteinuria (≥+2) with renal dysfunction (CrCl <60 mL/min) and the absence of any alternative cause for renal dysfunction or proteinuria | Proteinuria by urinary strip, eGFR by CG and MDRD | Not mentioned | 23.3% | Total prevalence: 23.3% Among patients with proteinuria, 5.3% had CrCl <60 mL/min. |
Low |
| Attolou118 | 1998, Benin, West | National Central Hospital | 92 | HIV-infected patients | Age (years): 22±4 Male gender: 68% |
Proteinuria >0.5 g/24 hours and SCr >14 mg/L | Serum creatinine measurement and 24-hour proteinuria | Not mentioned | Proteinuria >0.5 g/24 hours in 23.33% | Total prevalence: 27.16% | Low |
| Agaba170 | 2003, Nigeria, West | Infections unit of the Jos University Teaching Hospital | 126 | Consecutive 79 patients with AIDS and 57 controls | Not known | Not known | Not known | 25% (AIDS group) | Total prevalence among AIDS group: 51.80% CKD prevalence among control group: 12.2% |
Low | |
| Fana100 | 2011, Zimbabwe, South | Outpatient clinics | 159 | HIV-infected patients naïve to ART | CrCl <60 mL/min, proteinuria ≥+1 and/or PCR >20 mg/mg | Proteinuria by urinary strip and 24-hour proteinuria, eGFR by CG | Not mentioned | 45.90% | Total prevalence: 45.9% Among patients, 7.50% had CrCl <60 mL/min |
Low | |
| Han101 | 2006, South Africa, South | Medical centre | 615 | Patients with HIV not on ART | Age (years): 31 (range, 13–63) Male gender: 25% Proteinuria-negative: 117±14/70±9 Microalbuminuria: 121±15/81±10 Macroalbuminuria: 120±12/74±11 |
Microalbuminuria > urinary protein 30 and 300 mg/24 hours A cut-off serum creatinine level of 250 mmol/L was used to exclude those patients with advanced nephropathy. |
Proteinuria by urinary strip and 24-hour proteinuria, CG and MDRD | Not mentioned | 6% | Total prevalence (based on proteinuria): 6% | Low |
| Peters147 | 2008, Uganda, East | Home-based AIDS care | 508 | Patients with HIV starting HAART | Age (years): 39 (median) Male gender: 41% |
CrCl of 25–50 mL/min | CG, 175 MDRD | Kinetic Jaffe | Not measured | Total prevalence: 20% | Low |
| Jao110 | 2011, Cameroon, Central-West | Clinics | 389 | 199 HIV-positive and 190 HIV-negative pregnant women | Age (years): HIV-positive (27 (IQR: 24–31)) HIV-negative (27 (IQR: 22–31)) Male gender: 0 |
Proteinuria (PCR >200 mg/g) | Proteinuria by urinary strip and PCR | Not measured | HIV-positive: 39.2% HIV-negative: 20.9% |
Total prevalence among HIV-positive (based on proteinuria): 39.2% | Medium |
| Msango85 | 2011, Tanzania, East | Outpatient clinics | 355 | HIV-infected patients naïve to ART | Age (years): 36.1±7.9 Male gender: 35% BMI (kg/m2): 21.3±3.8 |
KDOQI | Proteinuria and albuminuria by urinary strip eGFR by CG, MDRD | Not mentioned | 36% proteinuria ≥+1 | Total prevalence: 85.6% | Low |
| Myer162 | 2013, South Africa, South | Primary healthcare clinic | 1861 | Consecutive 238 pregnant women, 1014 non-pregnant, 609 men; HIV-infected patients eligible for ART | Age (years): pregnant, 28 (IQR: 25–32), men, 37 (IQR: 32–45), women, 33 (IQR: 28–39) Male gender: 33% |
CrCl <60 mL/min | Absolute SCr and CG | Not mentioned | Not measured | Total prevalence: 5.8% | Low |
| Mulenga163 | 2008, Zambia, South | Clinic | 25 249 | HIV-infected, ART-naïve adults initiating treatment | Age (years): normal CrCl, 33.7±7.9, decreased CrCl, 38.5±9.9 Male gender: 39.7% |
CrCl <60 mL/min | Absolute SCr, eGFR by CG and MDRD | Not mentioned | Not measured | Total prevalence (MDRD): 3.2% | Medium |
| Adedeji158 | 2015, Nigeria, West | The University of Ilorin Teaching Hospital | 183 | Newly diagnosed HIV-infected ART-naïve patients | Age (years): 37.9+10.5 Male gender: 42.6% BMI (kg/m2): 20.88+3.56 |
eGFR <60 mL/min/1.73 m2 | Absolute SCr, eGFR by MDRD | Kinetic Jaffe and IDMS | Not measured | Total prevalence: 24% | Low |
| Anyabolu135 | 2016, Nigeria, West | Federal Medical Centre | 529 | 393 newly diagnosed drug-naïve patients with HIV, 136 age-matched and sex-matched HIV-seronegative controls | Age (years): 38.84±10.65 Male gender: 28% BMI categories <18.50.0 kg/m2: 7% 18.5–24.9 kg/m2: 35% 25–29.9 kg/m2: 32% ≥30 kg/m2: 23% |
24-hour urine protein ≥0.300 g and/or GFR <60 mL/min | Quantitative assessment of protienuira, SCr and eGFR | Not mentioned | Not mentioned | Total prevalence among HIV-positive patients: 22.9% Prevalence among HIV-negative: 8.1% |
Low |
| Ayokunle113 | 2015, Nigeria, West | Medical Out-patient Department of University of Ilorin Teaching Hospital | 335 | 227 newly diagnosed, ART-naïve patients with HIV/AIDS, 108 age-matched and sex-matched control | Age (years): 40.3±10.3 Male gender: 44% BMI (kg/m2): 20.5±4.8 among patients with HIV, 26.7±5.3 among control group SBP (mm Hg): 111.9±1 among patients with HIV, 126.1±12.0 among control group DBP (mm Hg): 72.9±9.5 among patients with HIV, 80.6±6.8 among control group |
Albuminuria ≥30 mg/g and/or eGFR <60 mL/mL/1.73 m2 | Proteinuria by dipstick, and ACR and eGFR by MDRD | Kinetic Jaffe | Not mentioned | Total prevalence among patients with HIV: 47.6% The prevalence among HIV-negative: 16.7% |
Low |
| Chadwick114 | 2015, Ghana, West | Komfo Anokye Teaching Hospital | 330 | Patients with HIV on ART | Age (years): 39 (IQR: 35–46) Male gender: 25% BMI (kg/m2): 22.9 (IQR: 20.5–26.6) |
Proteinuria or CrCl <60 mL/min | Proteinuria (dipsticks, PCR and ACR) and GFR by CG | Not mentioned | 37% by dipstick and 12% by PCR | Total prevalence (proteinuria): 37% CrCl <60 mL/min among 7% |
Low |
| Edwards166 | 2015, Kenya, East | Two primary care clinics | 2206 | 210 HIV-positive patients and 1996 HIV-negative | Age (years): HIV-positive: 43 (IQR: 39–50), HIV-negative: 49 (IQR: 40–56) Male gender: HIV-positive: 31%; HIV-negative: 28.7% Hypertension: HIV-positive: 44%; HIV-negative: 33.2% DM: HIV-positive: 5%; HIV-negative: 15.2% |
CrCl <60 mL/min | eGFR by CKD-EPI | Not mentioned | Not measured | Total prevalence: 12.1% HIV-positive: 17% HIV-negative: 11% |
Medium |
| Glaser14 | 2016, Malawi, East | Lighthouse Clinic | 363 | 116 HIV-positive ART-naïve patients and 247 HIV-negative patients | Age (years): 31 (IQR: 26–39) Male gender: 52% |
eGFR <60 mL/min | eGFR by CG, MDRD and CKD-EPI with and without correction factor | IDMS-calibrated creatinine and cystatin-C | Not measured | Total prevalence among HIV-positive (creatinine-based CKD-EPI): 1.9% | Medium |
| Glaser115 | 2016, Malawi, East | Lighthouse Clinic | 363 | 116 HIV-positive patients and 247 HIV-negative patients | Age (years): 34.1±10.9 Male gender: 52% BMI (kg/m2): 23.2±4.8 Hypertension: 13.5% |
KDOQI | Proteinuria by dipstick and ACR, eGFR by CG, MDRD and CKD-EPI | IDMS-calibrated creatinine and cystatin-C | 12.1% | Total prevalence: 13% Prevalence among HIV-positive: 22% Prevalence among HIV-negative: 9% |
Medium |
| Kamkuemah167 | 2015, South Africa, South | Gugulethu Community Health Centre |
1092 | HIV-infected patients initiated ART therapy | Age (years): 34 (IQR: 29–41) Male gender: 38% |
eGFR <60 mL/min | eGFR by CG | Not mentioned | Not measured | Total prevalence: 2% Prevalence by age <29 years: 17% 29–34 years: 28% 34–41 years: 5% >41 years: 50% Prevalence by gender Male: 28% Female: 72% |
Medium |
| Nsagha149 | 2015, Cameroon, Central-West | Government hospitals | 200 | Patients with HIV on HAART, DOTS or on the combined therapy (HAART/DOTS) | Age (years): 38.04±10.52 Male gender: 50.5% |
eGFR <60 mL/min per 1.73 m2 | eGFR by MDRD | Kinetic Jaffe | Not measured | Total prevalence: 8% | Low |
| Odongo94 | 2015, Uganda, East | Infectious Diseases Clinic of Gulu Regional Referral Hospital | 361 | Newly diagnosed patients with HIV not receiving ART | Age (years): 31.4±9.5 Male gender: 36.3% BMI (kg/m2)<18: 33% |
eGFR <60 mL/min/1.73 m2 | Proteinuria by dipstick and eGFR by MDRD | Not mentioned | Proteinuria ≥+1: 52% | Total prevalence: 14.4% Prevalence by gender Female: 16.5% Male: 10.4% |
Low |
| Okafor136 | 2016, Nigeria, West | University of Benin Teaching Hospital | 383 | HIV-infected naïve patients | Age (years): 36.03±9.08 Male gender: 41% |
eGFR <60 mL/min/1.73 m2 and/or evidence of kidney injury as detected when the PCR (mg/g) was ≥200 | Quantitative assessment of proteinuria by PCR and eGFR by MDRD | Kinetic Jaffe | Not mentioned | Total prevalence: 53.5% | Low |
| Seape156 | 2016, South Africa, South | Medical inpatients at the Chris Hani Baragwanath Hospital |
100 | HIV-infected naïve patients | Age (years): 37.0±9.6 Male gender: 60% BMI (kg/m2): 20.9±5.1 |
eGFR <60 mL/min/1.73 m2 | eGFR by CG, MDRD, CKD-EPI | IDMS | Not measured | Total prevalence: 16% | Low |
| Wensink137 | 2015, South Africa, South | Rural Medical Centre | 903 | HIV-infected adult patients | Age (years): 40 (IQR: 34–48) Male gender: 31% DM: 4% Hypertension: 23% |
Albuminuria or eGFR<60 mL/min/1.73 m2 | Albuminuria by ACR and eGFR by MDRD and CKD-EPI | Not mentioned | 21% | Total prevalence (albuminuria): 21% 2% had eGFR<60 mL/min/1.73 m2 |
Medium |
| Zachor157 | 2016, South Africa, South | Outpatient infectious clinic at an academic hospital | 650 | HIV-infected patients initiating ART | Age (years): 37.9±9.4 Male gender: 35.5% DM: 2.2% Hypertension: 7.8% |
eGFR <60 mL/min/1.73 m2 | eGFR by MDRD and CKD-EPI | IDMS | Not measured | Total prevalence: 2% | Medium |
| Mekuria150 | 2016, Ethiopia, East | Jimma University Specialised Hospital |
446 | 223 HAART-naïve and 223 HAART-experienced | Age (years): HAART-naïve: 38.25±10.8, HAART-positive: 35.14±9.2 Male gender: 37% BMI (kg/m2): HAART-naïve: 20.7±3.2, HAART-positive: 21.6±3.5 Hypertension: 3.36% DM: 21.4% |
eGFR <60 mL/min/1.73 m2 | eGFR by CG | Kinetic Jaffe | Not measured | Total prevalence: 18.2% | Medium |
ACR, albumin to creatinine ratio; ART, antiretroviral therapy; BMI, body mass index; CG, Cockroft-Gault; CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease-Epidemiology; CrCl, creatinine clearance; DBP, diastolic blood pressure; DM, diabetes mellitus; DOTS, directly observed treatment short course; eGFR, estimated glomerular filtration rate; ESRD, end stage renal disease; HAART, highly active antiretroviral therapy; IDMS, isotope dilution mass spectrometry; KDOQI, Kidney Disease Outcome Quality Initiative; MDRD, Modification of Diet in Renal Disease; SBP, systolic blood pressure; SCr, serum creatinine; uPCR, urinary protein to creatinine ratio.