Introduction in sub-saharian africa, in clinical practice only patients meeting the WHO criteria to start antiretroviral treatment undergone creatinine testing, by lack of reagents. Some patients with renal dysfunction are not diagnosed. Van Griensven et al. developed a clinical prediction score (CPS), to accurately identify Cambodian patients, with median baseline body weight of 49 kg (IQR: 43–55), who need a creatinine test before initiating antiretroviral therapy, based on the post-test probability of renal dysfunction. We evaluated the performance of this CPS for predicting patients at risk of kidney dysfunction (KD) in Brazzaville, Congo.
Methods The CPS includes following predictors: age (score +2 if>40 years), body weight (score +2 if <45 kg), and haemoglobin (score +1 if>10 g/dL), the alternative CPS includes: age (score +2 if>40 years), body weight (score +2 if<45 kg), sex (score +1 if female), and WHO stage (score +1 if WHO stage III/IV). The overall test performance of the CPS was assessed by calculating the area under the receiver-operating characteristic (AUROC) curve. We defined KD as an estimated creatinine clearance based on the Cockcroft - Gault equation, by using two threshold, <50 (CG1) and <60 (CG2) mL/min.
Results Among 545 patients, median values was: body weight 55 kg (IQR 48–63), age 38.87 years (33.18–46.21); 76 (13.95%) and 142 (26.06%) patients, respectively for CG1 and CG2, had KD. AUROC was 0.6183 (CPS) and 0.5815 (alternative CPS) for CG1 (p=0.0541), 0.7140 (CPS) and 0.6691 (alternative CPS) for CG2 (p=0.0016).
Conclusion Because the baseline body weight of African is high than in Cambodian patients, the CPS must be designed for African patients, it is a useful supplement to clinical judgment in the era of limited resources.
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