Incidence and risk factors of renal dysfunction among hiv positive patients on nevirapine based regimens at Kenyatta national hospital

Abstract

ntroduction As patients infected with human immunodeficiency vi rus (HIV) live longer while receiving antiretroviral therapy, kidney diseases h ave emerged as significant causes of morbidity and mortality. Black race, older age, hypertension, diabetes, low CD4+ cell count, and high viral load remain important ri sk factors for kidney disease in this population. Chronic kidney disease should be diagno sed in its early stages through routine screening and clinicians should pay careful attention to changes in glomerular filtration rate or creatinine clearance. With early detection and treatment, it is possible to prevent kidney disease and its co mplications from worsening. Objectives : The broad objective of this study was to evaluate t he incidence and risk factors of renal dysfunction in HIV adult patients on Nevirapi ne based regimens. Methodology : This was a descriptive (right censored arm) hospita l based retrospective cohort study. It was carried out at the Kenyatta National Hospita l Comprehensive Care Center and targeted HIV patients on Nevirapine based regimens seen at the KNH-CCC. Data was collected between May and August 2014. The part icipants were sampled by convenient sampling technique. Ethical approval was obtained from the KNH-UoN Research and Ethics Committee. Quantitative data wh ich was obtained from the patient interviews and abstraction of patient files was analyzed using STATA version 10 software. Ordered Logistic regression modeling w as used to identify covariates that determine the severity of nephrotoxicity. Results : In total, 241 HIV-infected adult patients were incl uded in this study. There were 56 male and185 female patients. The median age was 39 years [IQR 35-44]. The duration of follow up for most of the patients was 5 years. The prevalence of renal dysfunction at baseline was 6.3% and the incidence in the study was 4.3%. In this study ive (2.1%) patients had estimated GFR (eGFR) < 50 mL/min per 1.73 m 2 , while ten (8.3%) patients had elevated serum creatinine (abov e 120μ g/l). In the multivariate ordered logistic regression the significant predict or variables for renal dysfunction that were significant were age at diagnosis, curren t age at the time of study, the sex, alcohol consumption and the duration of therapy. The females had a higher risk of developing renal d ysfunction (adjusted O.R 0.48 (95% C.I 0.24-1.04) p=0.04). Alcohol consumption wa s a significant predictor of renal dysfunction (adjusted O.R 1.84 (95% C.I 1.01- 3.29) p=0.04). Intensity of alcohol consumption has not been reported as a pred ictor of renal disease in HIV patients on HAART. This is the first study to repor t alcohol use as a risk factor. Conclusion and Recommendation : Renal dysfunction might occur in HIV patients on ne virapine based regimens evidenced by the incidence of 4.3%. The risk factor s identified in this study include age at diagnosis, alcohol consumption, duration of therapy and the female gender. The elevated serum creatinine level at baseline is a key indicator in the management of renal dysfunction. Routine eGFR calculations sho uld be done at each clinical visit. Early detection and vigilant monitoring is require d for patients with the known risk factors; systematic screening and appropriate refer rals for kidney disease management should be advocated for improved patient care. Larger studies comparing the contribution of other NNRTIs is recom mended