The baseline glomerular filtration rate, predictive of six-year survival in sub-Saharan African patients on antiretroviral therapy for HIV: Cohort study.

BACKGROUND: Recently, serious morbidity events associated with initial glomerular filtration rate (GFR) have been described during HIV infection, but this is insufficiently investigated in sub-Saharan Africa very affected by HIV. OBJECTIVE: To assess the impact of baseline GFR prevailing during the first semester of the HIV infection management on six-year survival in peoples taking antiretroviral therapy. PATIENTS AND METHODS: Closed retrospective cohort study. The death was the expected outcome, the baseline GFR (mL/min/1.73m2) in the first semester of the follow-up was the main exposure. Kaplan-Meier method, Cox regression were used for analysis. RESULTS: According to baseline GFR: <60, 60-89 and≥90, the six-year survival was 81.6%; 95.8% and 96.4% (P=0.067 Breslow). Adjusted hazard ratio for baseline GFR<60 and 60-89 (vs. ≥90) were respectively 5.4 (95%CI: 1.4-19.9; P=0.012) and 1.2 (95%CI: 0.3-4.0; P=0.754). The etiological fraction of deaths attributable to baseline GFR: GFR<60: 81% (95%CI: 0.31-0.95), GFR=60-89: 18.0% (95%CI: -0.7-0.8). Prognostic concordance index=0.84 (95%CI: 0.59-0.95) for GFR<60 and 0.55 (95%CI: 0.27-0.81) for GFR 60-89. DISCUSSION: The etiological fraction of death and prognostic concordance index associated to baseline GFR level increase significantly with decline of baseline GFR. CONCLUSION: Baseline GFR seems to predict the six-year survival in African sub-Saharan patients treated for HIV.

Intravenous infusion of glucose 5% despite sodium mixed, is main contributor of acquired hyponatremia in adult polyvalent medicine service: Case control study.

BACKGROUND: Acquired hyponatremia is a life threatening event. Intravenous infusion of a mixture of 5% glucose and sodium solute is mainly used, but its contribution in the occurrence of acquired hyponatremia in adult, is under-investigated outside intensive care unit. OBJECTIVE: To evaluate the place of intravenous infusion of a mixture of 5% glucose and sodium in predicting acquired hyponatremia in adult polyvalent medicine service. PATIENTS AND METHODS: A case-control study have been conducted. The main exposure was intravenous infusion of a mixture of 5% glucose and sodium solute (4 grams NaCl/liter of 5% glucose). OUTCOME: Acquired hyponatremia during hospitalization. By logistic regression, the global multifactorial model predicting acquired hyponatremia, and its sub-models were established; as well as following parameters: area under the Receiving Operator Characteristic curve (AUC), maximal Youden's index with its couple of coordinates (sensibility-specificity), Nagelkerke's R-squared adjusted. RESULTS: Adjusted odds ratio (cases/controls; main exposure; outcome) ORa=2.73 (95% CI 1.40-5.32; P=0.003). Prediction of acquired hyponatremia: global multifactorial model: AUC=0.78 (95% CI 0.72-0.85; P<0.0001), Youden's index=0.34 (95% CI 0.24-0.41); sub-model (global multifactorial model without main exposure): AUC=0.72 (95% CI 0.66-0.78; P<0.0001), Youden's index=0.18 (95% CI 0.07-0.22). CONCLUSION: Intravenous infusion of a mixture of 5% glucose and sodium mainly used, highly contribute to predict acquired hyponatremia in adult polyvalent medicine service, and should be the first cause to consider for managing this acquired hyponatremia.