The Prevalence of Kidney Dysfunction and Associated Risk Factors among ART-Naïve HIV-1 infected Adults at the University Teaching Hospital in Lusaka, Zambia

Abstract

Background: Chronic HIV infection is associated with renal complications including renal dysfunction. Risk factors found in literature for kidney disease in the HIV population include hypertension, Diabetes mellitus, cardiovascular disease, low CD4 count, high viral load, hepatitis C virus co-infection, hypoalbuminemia, a family history of CKD, black race, and nephrotoxic drugs. The 2016 Zambian Consolidated guidelines for the prevention and treatment of HIVrecommends use of a kidney disease screening algorithm to guide choice of a cART regimen in the absence of serum creatinine. Despite using the Kidney disease screening algorithm, the risk factors listed in this algorithm have not been validated in our HIV-infected population. Therefore, this study aimed to determine the prevalence of renal dysfunction and validate the risk factors listed in the kidney disease screening algorithm in the ARTnaïve HIV-infected adults.
General objective: To determine the prevalence of renal dysfunction and associated risk factors in ART naïve HIV infected adults at the University Teaching Hospital, Lusaka.
Methods: This was a cross sectional analytical study with 360 participantsenrolled. A structured questionnaire was used to collect data. Blood and urine samples were collected for creatinine, CD4 count, HIV-1 viral load, serum albumin, hepatitis B surface antigen, Hepatitis C antibody, Random blood sugar, and urinalysis.Data was entered onto a Microsoft office excel spread sheet, and analyzed using STATA version 13.We investigated the association between the dependent variable and each independent variable.
Results: The prevalence of renal dysfunction was 24.76%. The overall mean age for the sample population was 36.62 years comprising more females (54.63%) than males. Hypertension OR=2.63, (95% CI 1.11, 6.12) was the only factor found to be predictive of renal dysfunction.
Conclusion: We recommend routine screening for hypertension in HIV cART naïve individuals and those found to be hypertensive should be further investigated for renal dysfunction prior to initiation of cART.