Abstract
BackgroundSince little is known about chronic kidney disease (CKD) among people living with HIV/AIDS (PLWHA) in Sub-Saharan Africa, the prevalence and nature of CKD were assessed in Burundi through a multicenter cross-sectional study.MethodsPatients underwent assessments at baseline and 3 months later. Glomerular Filtration Rate (GFR) was estimated using abbreviated 4-variable Modification of Diet in Renal Diseases (MDRD) and Cockroft-Gault estimation methods. Patients were classified at month 3 into various CKD stages using the National Kidney Foundation (NKF) definition, which combines GFR and urinary abnormalities. Risk factors for presence of proteinuria (PRO) and aseptic leukocyturia (LEU) were further analyzed using multiple logistic regression.ResultsMedian age of the patients in the study (N = 300) was 40 years, 70.3% were female and 71.7% were on highly active antiretroviral therapy. Using the MDRD method, CKD prevalence in patients was 45.7%, 30.2% of whom being classified as stage 1 according to the NKF classification, 13.5% as stage 2 and 2% as stage 3. No patient was classified as stage 4 or 5. Among CKD patients with urinary abnormality, PRO accounted for 6.1% and LEU for 18.4%. Significant associations were found between LEU and non-steroidal anti-inflammatory drug (NSAID) use, previous history of tuberculosis, low body mass index and female gender and between PRO and high viral load.ConclusionOur study, using a very sensitive definition for CKD evaluation, suggests a potentially high prevalence of CKD among PLWHA in Burundi. Patients should be regularly monitored and preventative measures implemented, such as monitoring NSAID use and adjustment of drug dosages according to body weight. Urine dipsticks could be used as a screening tool to detect patients at risk of renal impairment.
Highlights
Since little is known about chronic kidney disease (CKD) among people living with HIV/AIDS (PLWHA) in Sub-Saharan Africa, the prevalence and nature of CKD were assessed in Burundi through a multicenter cross-sectional study
Two hundred and five patients (69.8%) were on highly active antiretroviral therapy (HAART), with a median duration of 1 year (IQR 1-3) and 47.9% had previously been treated with non-steroidal anti-inflammatory drugs (NSAID)
IQR, Inter Quartile Range; 95% CI, 95% Confidence Interval; HAART, Highly Active Antiretroviral Therapy; NSAID, Non Steroidal Anti-Inflammatory Drugs; GFR, Glomerular Filtration Rate; Modification of Diet in Renal Diseases (MDRD), Modification of Diet in Renal Disease
Summary
Since little is known about chronic kidney disease (CKD) among people living with HIV/AIDS (PLWHA) in Sub-Saharan Africa, the prevalence and nature of CKD were assessed in Burundi through a multicenter cross-sectional study. Since the era of highly active antiretroviral therapy (HAART), mortality and morbidity among HIV-infected patients in high-income countries have dramatically shifted from opportunistic infections (OI) to chronic conditions [1]. Since 1995 in the United States, chronic kidney diseases (CKD) have become the fourth leading cause of mortality among HIV-infected patients [2]. Patients from Sub-Saharan Africa (SSA) are of particular concern, since they accumulate CKD risk factors both related to HIV (late HIV diagnosis, OI, nephrotoxic OIor HIV-related drugs) and non-related (hypertension, diabetes and ethnicity) [4,5,6,7]. Data that is available on CKD prevalence in PLWHA ranges from 6% to 45%, a variety of definitions have been used [7,8,9,10,11]
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