Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia

Abstract

Aim To evaluate the prevalence and associated factors of abnormal renal function among Ethiopian HIV-infected patients at baseline prior to initiation of antiretroviral therapy (ART) and during follow-up. Methods We conducted a retrospective observational cohort study of HIV infected patients who initiated ART at the outpatient ART clinic of Mehal Meda Hospital of North Shewa, Ethiopia from January 2012 to August 2018. Demographic and clinical data were abstracted from the medical records of patients. Renal function was assessed by estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Univariate and multivariate analysis were conducted to determine the factors associated with abnormal renal function at baseline and during follow-up. Results Among 353 patients, 70 (19.8%) had baseline eGFR <60 ml/min/1.73m2 and 102 (28.9%) had eGFR = 60–89.9 ml/min/1.73m2. Factors associated with baseline renal impairment (eGFR <60 ml/min/1.73m2) included female sex (AOR = 3.52, CI 1.75–7.09), CD4 count < 200 cells/mm3 (AOR = 2.75, CI 1.40–5.42), BMI < 25 Kg/m2 (AOR = 3.04, CI 1.15–8.92), low hemoglobin (AOR = 2.19, CI 1.16–4.09) and high total cholesterol (AOR = 3.15, CI 1.68–5.92). After a median of 3.0 years of ART, the mean eGFR declined from 112.9 ± 81.2 ml/min/1.73m2 at baseline to 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001). The prevalence of renal impairment increased from 19.8% at baseline to 22.1% during follow-up. Of 181 patients with baseline normal renal function, 49.7% experienced some degree of renal impairment. Older age (AOR = 3.85, 95% CI 2.03–7.31), female sex (AOR = 4.18, 95% CI 2.08–8.40), low baseline CD4 (AOR = 2.41, 95% CI 1.24–4.69), low current CD4 count (AOR = 2.32, 95% CI 1.15–4.68), high BMI (AOR = 2.91, 95% CI 1.49–5.71), and low hemoglobin (AOR = 3.38, 95% CI 2.00–7.46) were the factors associated with renal impairment during follow-up. Conclusion Impaired renal function was common in HIV-infected patients initiating ART in an outpatient setting in Ethiopia, and there appears to be a high prevalence of renal impairment after a median ART follow-up of 3 years. There is a need for assessment of renal function at baseline before ART initiation and regular monitoring of renal function for patients with HIV during follow-up.

HIV positive patients on HAART continue to have a decline in renal function irrespective of Tenofovir usage: A 2-year cohort from an Indian tertiary care centre

“…reported a decline in renal function in patients being started on HAART in Ethiopia. 23 Szczech et al also reported an absence of any beneficial effect of HAART or viral suppression on the decline in renal function observed in their study. 24 Pujari et al, through a study conducted at both the Institute of Infectious Diseases (IID) Pune, Western India, and the Royal Free Hospital (RFH) London, observed that there was a statistically significant decline in eGFR from baseline at 6 and 24 months at both the sites.…”

“…6 A 6-year cohort by Fiseha et al reported a decline in renal function in patients being started on HAART in Ethiopia. 23 Szczech et al also reported an absence of any beneficial effect of HAART or viral suppression on the decline in renal function observed in their study. 24…”

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

“…Among people living with HIV, the kidney is affected by direct HIV infection of the renal epithelial cells, deposition of immune complexes, and toxicities from drugs used to treat HIV (Tenofovir Disoproxil Fumarate (TDF), protease inhibitors, or HIV-related opportunistic infections (amphotericin B) (20)(21)(22). Although ART initiation is protective against kidney diseases, especially HIV-associated nephropathy (23), there is evidence of increased prevalence of kidney diseases after ART initiation (24)(25)(26). CKD is among the 10 most common non-infectious complications of HIV in the US (20,27).…”

Kidney damage in HIV infection: pathogenetic aspects, clinical and morphological variants and the role of antiretroviral therapy

“…В связи с чем, важно мониторировать не только уровень иммунорегулирующих клеток, но и функцию почек у лиц с ВИЧ-инфекцией вне зависимости от стадии заболевания. T. Fiseha и A. Gebreweld оценивали распространенность и факторы, влияющие на величину СКФ среди эфиопских ВИЧ-позитивных пациентов на исходном уровне до начала АРТ и во время последующего наблюдения [53]. Исследователи оценивали функцию почек с помощью СКФ, рассчитанной по методике MDRD.…”

“…Отдельно следует отметить, что в указанном исследовании распространенность почечной недостаточности увеличилась с 19,8% (исходно) до 22,1% в течение периода наблюдения. В течение всего периода наблюдения факторами, способствующими развитию почечной недостаточности, оказались пожилой возраст (ОШ 3,85, 95% ДИ 2,03-7,31), женский пол (ОШ 4,18, 95% ДИ 2,08-8,40), низкий исходный уровень CD4-клеток (ОШ 2,41, 95% ДИ 1,24-4,69), низкое текущее количество CD4 (ОШ 2,32, 95% ДИ 1,15-4,68), высокий ИМТ (ОШ 2,91, 95% ДИ 1,49-5,71) и низкий гемоглобин (ОШ 3,38, 95% ДИ 2,00-7,46) [53].…”