International Mentored Scientist Award

Assessment of chronic kidney disease and its progression among older people living with HIV in Uganda

Award date
Award cycle
Award amount - Direct


In Uganda, people living with HIV(PLWH) are growing into old age owing to increased access to antiretroviral therapy. Despite this success, living with HIV has been associated with a substantial burden of non-communicable diseases like diabetes mellitus, hypertension, and they are particularly three times likely to get chronic kidney disease (CKD) than the HIV-negative population. Diagnosis and stratification of CKD rely on glomerular filtration rate (GFR) estimation based on creatinine, a biomarker that is affected by multiple non-GFR determinants like muscle mass, frailty, and physical activity. In contrast, cystatin C has fewer non-GFR determinants and may more objectively estimate GFR in old PLWH. Compared with creatinine, cystatin C may more accurately risk stratify patients at high risk of poor outcomes like mortality, cardiovascular risk, and kidney failure. Additionally, differences between creatinine and cystatin C have been shown to predict these adverse outcomes in research done in well-resourced countries where population characteristics may be different from those of PLWH in Uganda and sub-Saharan Africa. In this study, we aim i) to compare the burden of CKD at baseline between cystatin C- and creatinine-based estimates of glomerular filtration rate (eGFRcys and eGFRcr, respectively) among older PLWH in Uganda and ii) to estimate the differences in longitudinal eGFRcys and eGFRcr over 2 years and determine baseline predictors of diverging eGFRcys and eGFRcr among older PLWH in Uganda. To accomplish these aims, we will capitalize on the prospective HIV geriatric cohort in sub-Saharan Africa (HASA) which comprises 500 PLWH aged 60 years residing in Uganda. Study results will provide an understanding of the utility of cystatin C in assessing CKD and the implications for diverging eGFRcys and eGFRcr on CKD progression among older PLWH. Data may form a foundation for implementing cystatin C measurements in routine screening and diagnosis of CKD in older PLWH.