Prevalence And Factors Associated with Glomerular Hyper Filtration Among People Living with Human Immunodeficiency Virus at Bugando Medical Centre, Mwanza, Tanzania. A Hospital-Based Cross-Sectional Study.
- Mwanza, Tanzania | Catholic University of Health and Allied Sciences [CUHAS-Bugando] | 2024.
- 90 Pages Includes References
Abstract:
Background: Glomerular hyper filtration (GHF) is an absolute increase in glomerular filtration rate (GFR) that exceeds the reserve capacity of renal function as an adaptive response and compensatory mechanism for kidney damage. GHF is an early marker of kidney damage that precedes the decline in glomerular filtration rate (GFR) progressing to chronic kidney disease (CKD). GHF is more common in people living with human immunodeficiency virus (PLHIV), with an estimated prevalence range of 17%-40% worldwide, while in Tanzania the prevalence of GHF has been reported to be 42% among PLHIV on ART.
Objective: To determine the prevalence and factors associated with glomerular hyper filtration among people living with human immunodeficiency virus at Bugando Medical Centre, Mwanza, Tanzania.
Methodology: A hospital-based cross-sectional study was conducted at the Bugando Medical Centre (BMC) HIV Care and Treatment Centre (HCTC). A total of 376 PLHIV, adults aged ≥18 years, were enrolled after meeting the inclusion criteria. Structured questionnaires were used to collect demographic and clinical information. Blood samples were collected to assess serum creatinine, fasting blood glucose, haemoglobin levels, CD4 cells and HIV viral load. Urine samples were collected to assess proteinuria. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI). Glomerular hyper filtration was defined as any value of eGFR≥ 125 mL/min/1.73 m2. Multivariable logistic regression was used to identify independent factors associated with GHF. Data were analyzed using STATA version 15.
Results: Among 376 PLHIV were enrolled in our study, 51.9% had absolute glomerular hyper filtration. Factors associated with GHF were proteinuria, hypertension, and diabetes mellitus, past smoking, TDF use, and low levels of aerobic activities. Female sex and age >55 years were found to be protective factors for the development of GHF. HIV WHO clinical stage III and IV, CD4<350 cells/microL, detectable HIV viral load and previous exposure to non-TDF-based regimens were not associated with GHF.
Conclusion: Our results show a high prevalence of glomerular hyper filtration in PLHIV. Therefore, routine assessment of serum creatinine and estimation of glomerular filtration rate in PLHIV with proteinuria, hypertension, diabetes mellitus and a history of smoking, TDF use and low level aerobic activity may help identify patients who would benefit from evidence-based interventions that can prevent progression of GHF to chronic kidney disease.
Wurzburg Road 35, Premises, Post Code: 33102 | P. O. Box 1464 Mwanza, Tanzania | Phone: (255) 28-298-3384 | Fax: (255) 28-298-3386 | Email: vc@bugando.ac.tz | Website: www.bugando.ac.tz