The Epidemiology of Chronic Kidney Disease among Young People Living with HIV in Uganda.

Background: Chronic kidney disease (CKD) is among the top 10 non-infectious complications among young people living with HIV (YPLHIV). There is a lack of surveillance, screening and reporting of CKD in most low- and middle-income countries, partially due to the unknown epidemiology of CKD among YPLHIV. In this PhD, I estimated the prevalence, described the risk factors, presentation, and comorbidities associated with CKD among YPLHIV in Uganda and compared performance characteristics of cystatin C and serum creatinine. I also tested the diagnostic utility of an albuminuria point-of-care (POC) test. Methods: I conducted a systematic review and meta-analysis to describe the burden of CKD among YPLHIV in SSA, a cross-sectional study involving 500 YPLHIV to determine the prevalence and associated factors of CKD diagnosed with cystatin C or creatinine-based glomerular filtration rate (GFR) estimates, and a nested unmatched case-control study where I recruited 92 cases and 196 controls, to identify the comorbidities associated with CKD among YPLHIV in Uganda. I conducted a diagnostic test study to determine the sensitivity and specificity of the albuminuria test compared to a reference standard. I used descriptive statistics and logistic regression to analyse the data. Results: The systematic review and meta-analysis showed a pooled CKD prevalence of 1% (95% CI 6.0–19.5%) with a range of 0.8%-53.1% with considerable heterogeneity. Among the 500 YPLHIV in Uganda, CKD prevalence ranged from 0 to 23% depending on the definition, estimating equation and biomarker used. Factors associated with CKD were age, sex and viral suppression. The associated comorbidities were bone mineral disease, hyperchloremia, and low haematocrit. The POC test has a sensitivity of 74.5% (95% CI 70.6-78.4%) and a specificity of 68% (95% CI 63.9-72.3%). Conclusion: The prevalence of CKD in YPLHIV depends on the definition, biomarker and estimating equation used. There is an urgent need to validate a GFR estimating equation for YPLHIV to avoid misclassifying those with CKD. More research is needed to discern the pattern of CKD and the comorbidities that YPLHIV with CKD are prone to. Cystatin C could replace serum creatinine as the biomarker of choice for the diagnosis of CKD. The POC was not sensitive enough to be recommended as a CKD screening test