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Abstract
BackgroundKidney diseases have emerged as significant cause of morbidity and mortality in HIV subject on antiretroviral therapy (ART). In Ghana, routine follow up of HIV positive clients is by estimation of serum creatinine and urea levels. Glomerular Filtration Rate (GFR) is not routinely calculated and proteinuria is not routinely checked. This study sought to investigate the kidney profiles of adult HIV/AIDS patients being managed on ART at the Cape Coast Teaching Hospital (CCTH), Ghana.MethodsA hospital-based analytical cross sectional study with a retrospective component was conducted using systematic sampling method to recruit HIV/AIDS who visited the ART clinic. A total of 440 participants of both sexes aged 18 years and above, confirmed as HIV/AIDS positive and on ART were involved in this study. Blood and urine samples were collected from all subjects and the levels of serum creatinine and urea and proteinuria were estimated and eGFR calculated using the Modification of Diet in Renal Disease (MDRD) equations. Data analyses were performed using Stata version 13 software (Stata Corp, Texas USA).ResultsThe mean age (years) of participants was 45.5 years (±11.6) with 288 (65.4%) being on Tenofovir based ART regimen. The mean eGFR was found to decrease from 112.4 ml/min/1.73 m at baseline, to 103.4 ml/min/1.73 m after 6 months on ART and to a mean of 99.4 ml/min/1.73 m at recruitment into this study. Factors which were found to be associated with having eGFR < 60 included age, gender and CD4 count though not statistically significant. Patients > 45 years had the highest odds with OR 2.0 (95% CI: 0.8–5.1), females had higher odds with OR 1.5 (95% CI: 0.5–5.2), and those with CD4 count > 350 had OR of 0.4 (95% CI 0.2–1.3). A total of 30.9% of the participants had proteinuria at recruitment. TDF based ART regimen had no statistically significant effect on serum creatinine and urea levels.ConclusionEstimated GFR decreased after 6 months among patients on ART despite normal serum creatinine and urea levels. This finding suggests that clients in care at HIV/ART clinics in Ghana may benefit from routine estimation of GFR and proteinuria.
Highlights
Kidney diseases have emerged as significant cause of morbidity and mortality in HIV subject on antiretroviral therapy (ART)
The main aim of this study was to determine the serum concentration of creatinine, urea; urine protein and to grade the stage of the renal dysfunction among adult HIV/Acquired Immunodeficiency syndrome (AIDS) patients who are on ART based on Glomerular Filtration Rate (GFR) estimation at a tertiary facility in Ghana
Participant characteristics A total of 440 HIV positive individuals participated in this study
Summary
Kidney diseases have emerged as significant cause of morbidity and mortality in HIV subject on antiretroviral therapy (ART). This study sought to investigate the kidney profiles of adult HIV/AIDS patients being managed on ART at the Cape Coast Teaching Hospital (CCTH), Ghana. Recent publications attribute discontinuation of ART to increase HIV related mortality. This had necessitated recommendations for nephrotoxicity vigilance such as anticipation, early detection of risk factors through routine screening and implementation of preventative therapeutic strategies of ART induced kidney damage complications of long-term therapy and HIVAN [4, 7]. A recent study examining CKD in HIV-infected adult patients found a prevalence of 4.7% CKD; about 7% of the CKD population was ART-naïve [3]. A similar study in the Ashanti Region of Ghana reported a renal insufficiency prevalence of about 13 and 9% among HAART and HAART naïve patients respectively using the Cockcroft-Gault and the Modification of Diet in Renal Disease (MDRD) equation [8]
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