Risk factors for impaired renal function in HIV-infected and HIV-uninfected adults: cross-sectional study in North-Western Tanzania

Abstract

Background Although the burden of impaired renal function is rising in sub-Saharan Africa (SSA), little is known about correlates of impaired renal function in the region. We determined factors associated with estimated glomerular filtration rate (eGFR) and impaired renal function in HIV-infected and HIV-uninfected adults. Methods We undertook cross-sectional analysis of data from 1947 adults at enrolment for a cohort study on diabetes and associated complications in HIV patients in Mwanza, north-western Tanzania. A structured questionnaire was used to collect data on sociodemography, smoking, alcohol, physical activity, antiretroviral therapy (ART) and anthropometry. We measured blood pressure, tested blood samples for creatinine, glucose and HIV, and performed Kato Katz for Schistosoma mansoni. Correlates of eGFR (mL/min/1.73 m2) and impaired renal function (eGFR< 60 mL/min/1.73 m2) were determined using linear regression and logistic regression, respectively. Results 655 (34%) participants were HIV-uninfected, 956 (49%) were ART-naive HIV-infected and 336 (17%) were HIV-infected adults on ART. The mean age was 41 years (SD12) and majority (59%) were females. Overall, the mean eGFR was 113.6 mL/min/1.73 m2 but 111.2 mL/min/1.73 m2 in HIV-uninfected, 109.7 mL/min/1.73 m2 in ART-naive HIV-infected and 129.5 mL/min/1.73 m2 in HIV-infected ART-experienced adults, and respective prevalence of impaired renal function was 7.0, 5.7, 8.1 and 6.3%. Correlates of lower eGFR were increasing age, higher socioeconomic status, unhealthy alcohol drinking, higher body mass index and diabetes mellitus. Anaemia was associated with 1.9 (95% Confidence Interval (CI):1.2, 2.7, p = 0.001) higher odds of impaired renal function compared to no anaemia and this effect was modified by HIV status (p value 0.02 for interaction). Conclusion Impaired renal function is prevalent in this middle-aged study population. Interventions for prevention of impaired renal function are needed in the study population with special focus in HIV-infected adults and those with high socioeconomic status. Interventions targeting modifiable risk factors such as alcohol and weight reduction are warranted.

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020–2021

“…In this study, age was a strong predictor of reduced eGFR, a finding similar to other studies in SSA [ 10 , 11 , 12 ]. Studies have shown that chronic HIV infection accelerates aging and, even among ALHIV well controlled on ART, there is still an increased risk of age-related renal function loss [ 26 ].…”

“…eGFR was estimated from serum creatinine using the 2021 CKD-EPI equation and was used as a continuous outcome in the regression analysis. The 2021 CKD-EPI formula is a race-free formulae that has been widely used to assess renal insufficiency among Africans in SSA [ 11 , 12 ]. Use of race-based CKD-EPI has been shown to overestimate eGFR if applied among African populations, consequently resulting in delayed initiation of nephrological care including dialysis initiation [ 31 , 32 , 33 ].…”

“…In Sub-Saharan Africa (SSA), where over two-thirds of the world’s population of ALHIV reside [ 3 ], the pooled prevalence of renal insufficiency among ALHIV is reported to be as high as 12% [ 8 , 9 ]. Renal insufficiency is also common among ALHIV in Tanzania, with prevalence ranging from 7 to 11% [ 10 , 11 , 12 , 13 ].…”

“…Other HIV infection-related risk factors include low CD4+ T cell counts, high HIV viral loads (VLs), and coinfection with hepatitis C and/or Hepatitis B virus [ 17 ]. ALHIV are also at risk for renal insufficiency from traditional risk factors [ 11 , 12 , 17 ], including older age, high BP, diabetes mellitus, dyslipidemia, obesity, and smoking, which are increasingly common among ALHIV in Tanzania [ 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Studies from the US have shown that persons of African descent are also at increased risk for renal insufficiency and disease due to polymorphisms in the apolipoprotein L1 (APOL1) gene [ 25 , 26 ].…”

Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV

“…Anemia exacerbates the progression of HIV-associated nephrotoxicity, leading to structural and functional changes in the kidneys and promoting the development of CKD [114]. Furthermore, erythropoietin deficiency, a common feature in HIV-related anemia, not only contributes to inadequate red blood cell production but is also implicated in renal injury, creating a dual mechanism through which anemia may impact kidney health [115], as shown in Figure 4. Chronic inflammation and immune activation characteristic of HIV infection create a pro-inflammatory environment, directly affecting renal function and contributing to CKD.…”