High prevalence of renal dysfunction and association with risk of death amongst HIV-infected Ghanaians
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Date
2013-03-28
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier Ltd.
Abstract
To determine the prevalence of HIV-associated renal dysfunction
(RD), identify risk factors for RD and explore the association between baseline renal function
and mortality in an HIV-infected population in Ghana.
Methods: Creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR) was calculated
in patients attending an HIV clinic between 2004 and 2011 using Cockcroft-Gault, MDRD
and CKD-EPI formulae. Logistic regression analysis was used to identify risk factors associated
with RD and KaplaneMeier/Cox proportional regression analyses to explore associations between
baseline CrCl/eGFR and subsequent mortality.
Results: In 3137 patients starting antiretroviral therapy (ART) the frequency (95%-CI) of RD,
defined by CrCl <60 ml/min/1.73 m2 using Cockroft-Gault formula was 38.8% (37.1e40.5%).
RD prevalence in a sub-population of 238 patients, including proteinuria in the definition,
was 15.3% (10.3e22.1%) in ART-treated and 43.6% (34.0e53.7%) in ART-na€ıve patients. RD at
baseline was associated with increasing age, low CD4 counts, advanced WHO stage and female
gender. Cox proportional hazard analysis identified an increased hazard of death with decreasing
CrCl, HR 1.46 (1.31e1.63) for each tertile lower than CrCl of 90 ml/min/1.73 m2.
Conclusions: RD is very common in HIV-infected ART-na€ıve Ghanaians, and associated with increased
risk of mortality. Screening and monitoring of RD is important in this setting, particularly
as tenofovir use increases.
Description
An article published by Elsevier Ltd and available at http://dx.doi.org/10.1016/j.jinf.2013.03.008
Keywords
HIV; Kidney; Renal; Africa; Antiretroviral therapy
Citation
Journal of Infection (2013) 67, 43e50