Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design
Abstract Background Individuals with two copies of the apolipoprotein-1 (APOL1) gene risk variants are at high risk (HR) for non-diabetic kidney disease. The presence of these risk variants is highest in West Africa, specifically in Nigeria. However, there is limited availability of dialysis and kid...
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2019-06-01
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Online Access: | http://link.springer.com/article/10.1186/s13063-019-3436-y |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Muktar H. Aliyu Usman J. Wudil Donna J. Ingles Bryan E. Shepherd Wu Gong Baba M. Musa Hamza Muhammad Mahmoud U. Sani Aliyu Abdu Aisha M. Nalado Akinfenwa Atanda Aima A. Ahonkhai Talat A. Ikizler Cheryl A. Winkler Jeffrey B. Kopp Paul L. Kimmel C. William Wester |
spellingShingle |
Muktar H. Aliyu Usman J. Wudil Donna J. Ingles Bryan E. Shepherd Wu Gong Baba M. Musa Hamza Muhammad Mahmoud U. Sani Aliyu Abdu Aisha M. Nalado Akinfenwa Atanda Aima A. Ahonkhai Talat A. Ikizler Cheryl A. Winkler Jeffrey B. Kopp Paul L. Kimmel C. William Wester Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design Trials APOL1 Microalbuminuria Kidney disease Lisinopril HIV Nigeria |
author_facet |
Muktar H. Aliyu Usman J. Wudil Donna J. Ingles Bryan E. Shepherd Wu Gong Baba M. Musa Hamza Muhammad Mahmoud U. Sani Aliyu Abdu Aisha M. Nalado Akinfenwa Atanda Aima A. Ahonkhai Talat A. Ikizler Cheryl A. Winkler Jeffrey B. Kopp Paul L. Kimmel C. William Wester |
author_sort |
Muktar H. Aliyu |
title |
Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design |
title_short |
Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design |
title_full |
Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design |
title_fullStr |
Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design |
title_full_unstemmed |
Optimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study design |
title_sort |
optimal management of hiv- positive adults at risk for kidney disease in nigeria (renal risk reduction “r3” trial): protocol and study design |
publisher |
BMC |
series |
Trials |
issn |
1745-6215 |
publishDate |
2019-06-01 |
description |
Abstract Background Individuals with two copies of the apolipoprotein-1 (APOL1) gene risk variants are at high risk (HR) for non-diabetic kidney disease. The presence of these risk variants is highest in West Africa, specifically in Nigeria. However, there is limited availability of dialysis and kidney transplantation in Nigeria, and most individuals will die soon after developing end-stage renal disease. Blocking the renin angiotensin aldosterone system with angiotensin-converting enzyme inhibitors (ACEi) is a well-recognized strategy to slow renal disease progression in patients with diabetes mellitus with chronic kidney disease (CKD) and in patients with HIV-associated nephropathy. We propose to determine whether presence of the APOL1 HR genotype alters or predicts responsiveness to conventional therapy to treat or prevent CKD and if addition of an ACEi to standard combination antiretroviral therapy (ART) reduces the risk of kidney complications among non-diabetic Nigerian adults. Methods/design We will screen 2600 HIV-positive adults who have received ART to (1) determine the prevalence of APOL1 risk variants and assess whether APOL1 HR status correlates with prevalent albuminuria, estimated glomerular filtration rate (eGFR), and/or prevalent CKD; (2) assess, via a randomized, placebo-controlled trial (RCT) in a subset of these participants with microalbuminura (n = 280) whether addition of the ACEi, lisinopril, compared to standard of care, significantly reduces the incidence or progression of albuminuria; and (3) determine whether the APOL1 HR genotype is associated with worse kidney outcomes (i.e. eGFR slope or regression of albuminuria) among participants in the RCT. Conclusions This study will examine the increasing prevalence of kidney diseases in HIV-positive adults in a West African population, and the relationship between these diseases and the APOL1 high-risk genotype. By evaluating the addition of an ACEi to the care of individuals with HIV infection who have albuminuria, our trial will provide definitive evidence to guide strategies for management and clinical care in this population, with the goal of reducing HIV-related kidney complications. Trial registration ClinicalTrials.gov, NCT03201939. Registered on 26 August 2016. |
topic |
APOL1 Microalbuminuria Kidney disease Lisinopril HIV Nigeria |
url |
http://link.springer.com/article/10.1186/s13063-019-3436-y |
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doaj-122a3a6fc295477496522990e7861ed62020-11-25T03:45:14ZengBMCTrials1745-62152019-06-0120111110.1186/s13063-019-3436-yOptimal management of HIV- positive adults at risk for kidney disease in Nigeria (Renal Risk Reduction “R3” Trial): protocol and study designMuktar H. Aliyu0Usman J. Wudil1Donna J. Ingles2Bryan E. Shepherd3Wu Gong4Baba M. Musa5Hamza Muhammad6Mahmoud U. Sani7Aliyu Abdu8Aisha M. Nalado9Akinfenwa Atanda10Aima A. Ahonkhai11Talat A. Ikizler12Cheryl A. Winkler13Jeffrey B. Kopp14Paul L. Kimmel15C. William Wester16Vanderbilt Institute for Global Health (VIGH)Vanderbilt Institute for Global Health (VIGH)Vanderbilt Institute for Global Health (VIGH)Department of Biostatistics, Vanderbilt University Medical CenterDepartment of Biostatistics, Vanderbilt University Medical CenterDepartment of Medicine, Aminu Kano Teaching HospitalDepartment of Medicine, Aminu Kano Teaching HospitalDepartment of Medicine, Aminu Kano Teaching HospitalDepartment of Medicine, Aminu Kano Teaching HospitalDepartment of Medicine, Aminu Kano Teaching HospitalDepartment of Pathology, Bayero University, Aminu Kano Teaching HospitalVanderbilt Institute for Global Health (VIGH)Department of Medicine, Division of Nephrology, Vanderbilt University Medical CenterBasic Research Laboratory, Molecular Genetic Epidemiology Section, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, NIHNational Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urologic and Hematologic Diseases, NIHNational Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urologic and Hematologic Diseases, NIHVanderbilt Institute for Global Health (VIGH)Abstract Background Individuals with two copies of the apolipoprotein-1 (APOL1) gene risk variants are at high risk (HR) for non-diabetic kidney disease. The presence of these risk variants is highest in West Africa, specifically in Nigeria. However, there is limited availability of dialysis and kidney transplantation in Nigeria, and most individuals will die soon after developing end-stage renal disease. Blocking the renin angiotensin aldosterone system with angiotensin-converting enzyme inhibitors (ACEi) is a well-recognized strategy to slow renal disease progression in patients with diabetes mellitus with chronic kidney disease (CKD) and in patients with HIV-associated nephropathy. We propose to determine whether presence of the APOL1 HR genotype alters or predicts responsiveness to conventional therapy to treat or prevent CKD and if addition of an ACEi to standard combination antiretroviral therapy (ART) reduces the risk of kidney complications among non-diabetic Nigerian adults. Methods/design We will screen 2600 HIV-positive adults who have received ART to (1) determine the prevalence of APOL1 risk variants and assess whether APOL1 HR status correlates with prevalent albuminuria, estimated glomerular filtration rate (eGFR), and/or prevalent CKD; (2) assess, via a randomized, placebo-controlled trial (RCT) in a subset of these participants with microalbuminura (n = 280) whether addition of the ACEi, lisinopril, compared to standard of care, significantly reduces the incidence or progression of albuminuria; and (3) determine whether the APOL1 HR genotype is associated with worse kidney outcomes (i.e. eGFR slope or regression of albuminuria) among participants in the RCT. Conclusions This study will examine the increasing prevalence of kidney diseases in HIV-positive adults in a West African population, and the relationship between these diseases and the APOL1 high-risk genotype. By evaluating the addition of an ACEi to the care of individuals with HIV infection who have albuminuria, our trial will provide definitive evidence to guide strategies for management and clinical care in this population, with the goal of reducing HIV-related kidney complications. Trial registration ClinicalTrials.gov, NCT03201939. Registered on 26 August 2016.http://link.springer.com/article/10.1186/s13063-019-3436-yAPOL1MicroalbuminuriaKidney diseaseLisinoprilHIVNigeria |