Prevalence and Predictors of Renal Dysfunction among HIV Infected Patients Starting Anti-Retroviral Therapy at the Bugando Medical Centre in Mwanza, Tanzania
- Mwanza, Tanzania: St. Augustine University of Tanzania c2010
- 82 Pages Includes Refernces and Appendices
Abstract:
Background: In Tanzania little is published on renal dysfunction amongst HIV infected individuals and no study has yet identified its prevalence or associated clinical and epidemiological factors.
Objectives: To determine the prevalence and predictors for dysfunction among HIV infected patients who were starting ART at the Bugando Care and Treatment Centre.
Materials and Methods: A cross-sectional study was conducted among HIV-infected patients at Bugando Care and Treatment Centre between November 2009 and June 2010. Adult’s patients undergoing counseling for initiation of ART were enrolled. Patients with diabetes mellitus, hypertension, febrile illness, HBV/HCV infection, or renal diseases not associated with HIV (SCD, UTI, pregnancy) were excluded. Patients were interviewed using standard questionnaires and physical examination was performed. Spot urine dipstick for proteinuria and micro albuminuria, CD4 count, serum creatinine, and renal ultrasound were performed to all patients. Both Cockcroft Gault and MDRD equations were used to estimate GFR.
Results: A total of 355 HIV patients were enrolled into this study. The mean age was 36. 1±7 years, of which 65% were females. Most patients (69%) were in HIV stage II disease. Most patients, 87% had CD4+T lymphocytes count less than 200cells/µl. About 13% had abnormal echogenic kidneys and 2.8% had enlarged echogenic kidneys on ultrasound, overall, 88.7% of patients had evidence of renal dysfunction (eGFR < 90mil/min/1.7m2 or micro albuminuria, but heavy proteinuria was rare. The prevalence of HIVAN was 11.8%. Lower rates of moderate to severe renal insufficiency were identified by the MDRD equation (33% vs. 17%) respectively, (p <10.001). On univariate analysis followed multivariate analysis female gender (OR 3.0, p<0.001, 95% CI 1.8-5.1), symptomatic HIV infection (OR 1.6, p<0.01, 95% CI 1.2-2.3), CD4 counts less than 200cell/µl (OR 2.2, p<0.04, 95% CI 1.1-4.8) and BMI<18.5 (OR 0.4, p<0.001, 95% CI 0.2-0.8, were independent predictors of severe renal dysfunction (eGFR<60mil/min/1.73m2).
Conclusions and Recommendations: The high prevalence of renal dysfunction among HIV-infected patients in our cohort underscores the need for routine, resource appropriate screening algorithms for renal dysfunction, and prior to the initiation of ART.