Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis.
Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0195443
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Okpechi IG
中科院分区：
文献类型：
--
作者：
Ekrikpo UE;Kengne AP;Bello AK;Effa EE;Noubiap JJ;Salako BL;Rayner BL;Remuzzi G;Okpechi IG
抗逆转录病毒疗法（ART）的广泛使用提高了艾滋病毒患者的预期寿命，使他们易患慢性非传染性疾病，包括慢性肾病（CKD）。我们进行了一项系统回顾和荟萃分析（PROSPERO注册号CRD42016036246），以确定HIV患者中CKD的全球和地区患病率。我们检索了PubMed、Web of Science、EBSCO和AJOL，检索了1982年1月至2016年5月间发表的文章。CKD定义为肾小球滤过率(eGFR) <60ml/min，使用MDRD、Cockcroft-Gault或CKD- epi方程。随机效应模型用于通过Freeman-Tukey变换稳定方差后综合各研究的患病率估计。在60个国家中选择了61篇符合条件的文章（n = 209,078名HIV患者）。MDRD患者的总体CKD患病率为6.4% (95%CI 5.2-7.7%)， CKD- epi患者为4.8% (95%CI 2.9-7.1%)， Cockcroft-Gault患者为12.3% (95%CI 8.4-16.7%)；估计量之间的差异P = 0.003。亚组分析确定了世卫组织各区域的患病率差异，其中非洲以耐多药耐药为基础的患病率最高，为7.9% （95%CI 5.2-11.1%）。在非洲，以耐多药病为基础的总患病率在西非最高[14.6% (95%CI 9.9% - 20.0%)]，在南部非洲最低（3.2%,95%CI 3.0-3.4%）。观察到的异质性可以用世卫组织地区、合并症高血压和糖尿病来解释，但不能用性别、乙型或丙型肝炎合并感染、CD4计数或抗逆转录病毒状态来解释。慢性肾病在艾滋病毒感染者中很常见，尤其是在非洲。HIV治疗项目需要加强对CKD的筛查，同时还需要引入HIV阳性患者CKD识别和治疗的全球指南。
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. 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. 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. 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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