Introduction Young people living with HIV (YPLHIV) are at increased risk of developing chronic kidney disease (CKD) which is associated with high mortality and morbidity. Early diagnosis is important to halt progression. We aimed to estimate the prevalence and factors associated with CKD among YPLHIV in Kampala, Uganda, and to compare serum creatinine and cystatin C for early diagnosis of CKD in this population. Methods A cross-sectional study with YPLHIV aged 10 to 24 years was conducted in seven HIV clinics. Participants provided a urine and blood sample to measure urinary albumin, proteinuria, serum creatinine and cystatin C levels at baseline and after three months. The estimated glomerular filtration rate (eGFR) was calculated using CKDEPI 2021, Cockroft-Gault and bedside Schwartz equations using creatinine or cystatin C. The albumin creatinine ratio (ACR) and proteinuria were measured. CKD was defined as either eGFR <60ml/min/1.73m2 or <90ml/min/1.73m2 or ACR above 30mg/g on two separate occasions. Univariable and multivariable logistic regression were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with CKD. Results A total of 500 participants were enrolled. Most were female (56%; n=280) and aged 10 to 17 years (66.9%; n=335). CKD prevalence ranged from 0-23% depending on the criteria, equation and biomarker used. Cystatin C-based equations estimated higher prevalence of CKD compared to creatinine-based ones. Prevalence of ACR above 30mg/g was 10.1% and of proteinuria 29%. Factors independently associated with CKD were age (aOR=1.42; 95% CI:1.30-1.51) and male sex (aOR=3.02; 95% CI:1.68-5.43). Conclusion CKD prevalence among YPLHIV varied substantially depending on definitions used and the current definition would likely lead to missed cases of CKD among YPLHIV. Estimating equations should be validated against measured GFR in YPLHIV and the optimal definition of CKD in this vulnerable population should be revised to optimise detection and opportunities for reducing disease progression.

The authors have declared no competing interest.

Support for research was provided by Fogarty International Centre, National Institutes of Health (grant #2D43TW009771-06) HIV and co-infections in Uganda. HAW is funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement (Grant 1: MR/R010161/1). EN, Doctoral Research Fellow, NIHR131273 is funded by the NIHR for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was received from the Uganda Virus Research Institute (UVRI) Research Ethics Committee (reference number GC/127/946), the Uganda National Council of Science and Technology (HS2578ES) and the London School of Hygiene and Tropical Medicine institutional review board (28797). Information about the study appropriate for adults, semi-literate adults and children was provided in an information booklet that was read to the participants and caregivers. All the participants more than 18 years of age provided a written informed consent. Those below 18 years of age provided assent and their caregivers provided written informed consent. If a child refused to provide assent even after their caregiver had provided consent, that child was not enrolled into the study. All participants had the option to withdraw at any point during the research. All participants with suspected CKD were referred to a nephrologist for management. Consent for publication: Not applicable

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