Impaired renal function and associated risk factors in newly diagnosed HIV-infected adults in Gulu Hospital, Northern Uganda.

Pancras Odongo,Paska Apiyo,Pauline Byakika-Kibwika,Ronald Wanyama,James Henry Obol

doi:10.1186/s12882-015-0035-3

Pancras Odongo, Paska Apiyo + Show 3 more

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https://doi.org/10.1186/s12882-015-0035-3

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Journal: BMC Nephrology	Publication Date: Mar 31, 2015
Citations: 46	License type: CC BY 4.0

Affiliation: Gulu University, Gulu Hospital, Makerere University

Abstract

BackgroundScreening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. We aimed to determine the status of renal function and factors associated with impaired renal function in newly diagnosed HIV-infected adults in Northern Uganda.MethodsThis was a seven month cross-sectional hospital-based study, involving newly diagnosed HIV-infected patients, 18 years and older. Patients with history of diabetes mellitus, hypertension and renal disease were excluded. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (Table one). Factors associated with impaired renal function (eGFR < 60 ml/min/1.73 m2) were thus sought.ResultsWe enrolled 361 participants (230, 63.7% female) with Mean ± standard deviation age of 31.4 ± 9.5 years. 52, (14.4%) had impaired renal function (eGFR <60 mL/min/1.73 m2) and of this 37 (71.2%) moderate renal impairment (eGFR 30–59.9 mL/min/1.73 m2) while 15 (28.8%) had severe renal impairment (eGFR <30 mL/min/1.73 m2). Proteinuria was recorded in 189 (52.4%) participants. Of these, 154 (81.5%) had mild (1+) while 8 (4.2%) had severe (3+) proteinuria. Using logistic regression, age, CD4 cell count, and proteinuria were significantly associated with impaired renal function; age >34 years (OR 2.8, 95% CI 1.3 – 5.9; P =0.009), CD4 count <350 cells/μL (OR 2.4, 95% CI 1.0-4.7; P =0.039) and proteinuria (OR 9.6, 95% CI 5.2–17.9; P < 0.001).ConclusionThe prevalence of impaired renal function was high in new HIV-infected individuals in this region with limited resources. So, screening for renal disease in HIV is recommended at the time of HIV diagnosis.

Highlights

Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection
Three hundred sixty five (365) antiretroviral therapy (ART) naïve HIV-infected patients were enrolled into the study
Defining renal impairment as Estimated glomerular filtration rate (eGFR)

Summary

Introduction

Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. Human immunodeficiency Virus (HIV) is a leading cause of morbidity and mortality especially in subSaharan Africa. Screening for renal disease is recommended for all HIV-infected individuals at diagnosis of the infection and at initiation of antiretroviral therapy (ART) [9]. Renal dysfunction at the time of initiation of ART or during ART is associated with complications such as faster progression to AIDS, high blood pressure, bone demineralization and anemia [10] which present significant challenges to HIV management especially in resource limited settings. Initiation of ART may improve the treatment outcomes of individuals with HIV-associated kidney disease [11]

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