Charlotte Boullé, Jérémy T Campillo, Marlhand C Hemilembolo, Elodie Lebredonchel, Valentin Dupasquier, Jean Claude Djontu, Sébastien D S Pion, Laurène Tardieu, Ludovic Rancé, François Missamou, Francine Ntoumi, Michel Boussinesq, Cédric B Chesnais
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Renal function was assessed via estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations, and proteinuria and/or haematuria (renal abnormalities, RAb). Multinomial logistic regression assessed associations between microfilarial density (MFD) and chronic kidney disease (CKD), using EKFC with Dubois correction. Population attributable fractions were estimated from a logistic model including Loa microfilaremia as a binary variable (present versus absent).</p><p><strong>Results: </strong>Among 986 participants, CKD prevalence ranged from 13.4% [95% confidence interval (CI) 11.4-15.7%, CKD-EPI] to 17.6% (95% CI 15.3-20.1%, EKFC) for KDIGO stages 1-5, and from 3.0% (95% CI 2.1-4.3%, CKD-EPI) to 7.6% (95% CI 6.1-9.4%, EKFC) for stages 3-5. Loa MFD was associated with higher odds of CKD, particularly in individuals with RAb. Compared to amicrofilaremic participants, those with Loa MFD ≥ 20 000 mf/ml had significantly increased risk: adjusted relative risk ratio (aRRR) for CKD severity categories (≤ 2nd, 2nd-10th, 10th-50th, > 50th eGFR percentile) with RAb were 8.67 (95% CI 2.62-28.64, P = 0.021), 14.26 (95% CI 3.41-59.68, P < 0.001), 5.50 (95% CI 0.55-61.78, P = 0.145), and 26.21 (95% CI 1.64-417.84, P = 0.021). Population attributable fractions of CKD stages 1-5 to Loa microfilaremia was 14.7% (95% CI 4.3-24.0) and 30.1% (95% CI 16.2-42.8) for CKD stages 1-5 with RAb.</p><p><strong>Conclusions: </strong>This study provides the first epidemiological evidence linking loiasis to renal impairment, likely via glomerular damage. Given loiasis high endemicity in Central Africa, it may contribute to the burden of unexplained nephropathies. 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引用次数: 0
摘要
背景：寄生虫病影响中非数百万人，虽然历史上被认为是良性的，但新出现的数据表明可能累及肾脏。本研究探讨了微丝虫病与肾功能的关系。方法：我们于2022年5月至6月在刚果共和国进行了一项横断面研究。使用慢性肾脏疾病-流行病学合作组织（CKD-EPI）和欧洲肾脏功能联盟（EKFC）方程，通过肾小球滤过率（eGFR）和蛋白尿和/或血尿（肾脏异常，RAb）评估肾功能。多项逻辑回归评估微丝密度（MFD）和慢性肾脏疾病（CKD）之间的关联，使用EKFC和Dubois校正。群体归因分数由logistic模型估计，包括微丝虫病作为二元变量（存在与不存在）。结果：在986名参与者中，KDIGO 1-5期的CKD患病率从13.4%[95%置信区间（CI） 11.4-15.7%， CKD- epi]到17.6% (95% CI 15.3-20.1%， EKFC)， 3-5期的CKD患病率从3.0% （95% CI 2.1-4.3%, CKD- epi）到7.6% （95% CI 6.1-9.4%， EKFC）。Loa MFD与较高的CKD发生率相关，特别是在RAb患者中。与非微丝血症参与者相比，Loa MFD≥20,000 mf/ml的参与者风险显著增加：CKD严重程度类别（≤2、2- 10、10 -50、bbb50 eGFR百分位数）与RAb的调整相对风险比（aRRR）分别为8.67 （95% CI 2.62-28.64, P = 0.021）和14.26 （95% CI 3.41-59.68， P）。结论：本研究首次提供了将loasis与肾脏损害联系起来的流行病学证据，可能通过肾小球损害。鉴于路易沙病在中非的高度流行，它可能会造成不明原因肾病的负担。有必要进行纵向研究和肾脏活检，以阐明潜在的机制。
Chronic kidney disease related to Loa loa microfilaremia in a rural area of the Republic of Congo: a population-based cross-sectional study.
Background: Loiasis affects millions in Central Africa and, though historically considered benign, emerging data suggest possible renal involvement. This study investigated the association between Loa microfilaremia and renal function.
Methods: We conducted a cross-sectional study in the Republic of Congo in May-June 2022. Renal function was assessed via estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations, and proteinuria and/or haematuria (renal abnormalities, RAb). Multinomial logistic regression assessed associations between microfilarial density (MFD) and chronic kidney disease (CKD), using EKFC with Dubois correction. Population attributable fractions were estimated from a logistic model including Loa microfilaremia as a binary variable (present versus absent).
Results: Among 986 participants, CKD prevalence ranged from 13.4% [95% confidence interval (CI) 11.4-15.7%, CKD-EPI] to 17.6% (95% CI 15.3-20.1%, EKFC) for KDIGO stages 1-5, and from 3.0% (95% CI 2.1-4.3%, CKD-EPI) to 7.6% (95% CI 6.1-9.4%, EKFC) for stages 3-5. Loa MFD was associated with higher odds of CKD, particularly in individuals with RAb. Compared to amicrofilaremic participants, those with Loa MFD ≥ 20 000 mf/ml had significantly increased risk: adjusted relative risk ratio (aRRR) for CKD severity categories (≤ 2nd, 2nd-10th, 10th-50th, > 50th eGFR percentile) with RAb were 8.67 (95% CI 2.62-28.64, P = 0.021), 14.26 (95% CI 3.41-59.68, P < 0.001), 5.50 (95% CI 0.55-61.78, P = 0.145), and 26.21 (95% CI 1.64-417.84, P = 0.021). Population attributable fractions of CKD stages 1-5 to Loa microfilaremia was 14.7% (95% CI 4.3-24.0) and 30.1% (95% CI 16.2-42.8) for CKD stages 1-5 with RAb.
Conclusions: This study provides the first epidemiological evidence linking loiasis to renal impairment, likely via glomerular damage. Given loiasis high endemicity in Central Africa, it may contribute to the burden of unexplained nephropathies. Longitudinal studies and renal biopsies are warranted to clarify underlying mechanisms.
期刊介绍：
Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
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