SAT-140 PREVALENCE AND ASSOCIATED FACTORS OF KIDNEY FAILURE IN HIV INFECTED PATIENTS ADMITTED FOR NON-RENAL CONDITIONS IN GENERAL MEDICAL WARDS OF SECONDARY HOSPITALS IN CAMEROON

Abstract

The prevalence of renal failure or renal dysfunction among HIV positive patients varies from 6% to 48.5% in most sub-Saharan African countries. However, most of those studies were conducted in tertiary health facilities with nephrology services. The burden among HIV positive patients admitted into general medical ward in district hospitals without nephrology services is unknown. Objective: Evaluate renal function in HIV positive patients admitted for non-renal conditions in a general medical ward of district hospitals in Yaounde, Cameroon. We conducted a cross sectional study over 3 months (January to April 2018) in the general medical wards of the five main secondary hospitals of Yaounde (political Capital of Cameroon). We excluded patients receiving high doses of cotrimoxazole (≥ 2880g/day), major limb amputees and patients with transurethral catheter. HIV infection was classified according to the OMS classification. Glomerular filtration rate was estimated using the MDRD equation. Kidney failure (KF) was defined as an eGFR < 60 ml/min/1.73m2 and classified as mild (60 < eGFR ≤ 30), severe (30 < eGFR ≤ 15) and very severe (eGFR < 15). We included 102 patients with 53% (n=52%) females. Mean age was 44.1 ± 12.2 years and 70 (67%) reported complimentary and alternate medicine (CAM) use. Hypertension (9%), diabetes (8%) and hepatitis B (10%) or Hepatitis C (4%) were infrequent. In all 84.5% (n=86) of patients were in OMS stage 3 and 4, and 71.5% (n=73) were on combined antiretroviral therapy (c-ART) with about two-thirds receiving tenofovir (n=61). Main reasons for admission were tuberculosis (31.5%), gastro-enteritis (18.6%) and malaria (17%). In all 26.5% (n=27) had proteinuria and the median eGFR was 88 [25th-75th IQ 45-122] ml/min/1.73m2 A total of 37.2% (n= 38) had kidney failure with mild KF in 53% (n=20), severe KF in 29% (n=11) and very severe KF in 18% (n=7). CAM use (82.5% Vs 62.5%, p=0.02) and proteinuria (55% Vs 9%, p<0.001) were more common in KF patients. Only proteinuria was associated with KF [adjusted OR =9.14 CI (3.16-28.13); p<0.001]. Kidney failure is very frequent among HIV positive patients admitted for non-renal condition in general medical ward. Evaluation of renal function needs to be systematic especially in patients using CAM and with proteinuria.