Prevalence of chronic kidney disease among ambulatory Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome patients on antiretroviral therapy at the Kenyatta National Hospital

Abstract

Background: Availability of antiretroviral therapy has had a profound positive effect on HIV/AIDS morbidity and mortality. Renal dysfunction is increasingly being recognized amongst antiretroviral exposed and naïve people living with HIV/ AIDS. Renal dysfunction is multifactorial and result from direct effects of the virus, some antiretroviral agents and drugs used for prophylaxis and treatment of opportunistic infections. Chronic kidney disease is expensive to treat besides being a strong independent risk factor for cardiovascular diseases.CKD is associated with higher mortality and morbidity in people living with HIV/AIDS Objective: To determine the prevalence of chronic kidney disease among ambulatory HIV/AIDS patients on antiretroviral therapy at Kenyatta National Hospital. Methodology: This was a Cross sectional observational study conducted between July and September 2014 that enrolled patients who were 18 years and above on HAART for at least one year. We used a structured questionnaire for clinical and demographic data. Urine and blood were collected from patients. Dipstick analysis and urine albumin and creatinine assay were done in urine and creatinine assay in blood.Serum creatinine was used to calculate estimated glomerular filtration rate using modified diet in renal disease formula. Association between presence of chronic kidney disease and preselected risk factors such as hypertension, diabetes mellitus,CD4+ count,age, HIV stage, prior tuberculosis treatment, duration of illness and treatment. Results: One hundred and fifty eight (158) patients were recruited. Average age was 43.3years with a range of 24-69 and 78.5% of the patients were female. Mean baseline CD4+ count was 212cells/ml(SD +/-174) and the most recent CD4+ was 496 cells/ml(SD +/- 242).Average duration since diagnosis of HIV was 5.7 years and that from ART initiation was 4.8 years. Diabetes mellitus and hypertension was seen in 5.7% and 12% of patients respectively. Evidence of chronic kidney disease was seen in 88% of patients ;17.6% had estimated glomerular filtration rate less than 60mls/min 1.73 and 86.3% had albuminuria.No preselected risk factors were found to have significant association with presence of CKD on univariate analysis. Prevalence of CKD in PLHA on HAART

Conclusion: There was a very high prevalence of CKD in patients on antiretroviral therapy at. Majority of the patients had proteinuria. Prevalence of Reduced glomerular filtration was high. No significant association was found between CKD and known risk factors assessed.