title: The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi.
abstract: 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 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.
  
  
  
  This 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.
  
  
  
  Out 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 m2accompanied by proteinuria with results as 11.2% vs. 1.2%, respectively for clients who were HIV-positive vs. HIV-negative (p = 0.001).
  
  
  
  Reduced 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.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany. nicola.glaser@posteo.de.
authors.forename: Nicola
authors.identifier: 0000-0002-8065-5677
authors.initials: N
authors.lastname: Glaser
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.|Department of Medicine, University of North Carolina, Chapel Hill, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Dominic
authors.initials: D
authors.lastname: Nsona
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.|International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nomeda
authors.initials: N
authors.lastname: Ahrenshop
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Neuhann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D018023:HIV Seronegativity / Q000502:physiology*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D012547:Schistosoma / Q000276:immunology; D012552:Schistosomiasis / Q000453:epidemiology; D012720:Severity of Illness Index; D014505:Urban Population; D055815:Young Adult
chemical_list: D000909:Antibodies, Helminth; D055316:Cystatin C; D003404:Creatinine
keywords: Chronic kidney disease; Glomerular filtration rate; HIV; LMIC; Malawi; Nephrology; Non-communicable diseases; Schistosomiasis; Sub-Saharan Africa