Longo AL, Lepira FB, Sumaili EK, Makulo JR, Mukumbi H, Bukabau JB, Mokoli VM, Kayembe PK, Nseka NM.
Division of Nephrology, Department of Internal Medicine, University of Kinshasa Hospital, University
J Acquir Immune Defic Syndr. 2012 Jan 1;59(1):59-64. doi: 10.1097/QAI.0b013e31823587b0

OBJECTIVE: To evaluate the prevalence of low estimated glomerular filtration rate (eGFR), proteinuria, and associated risk factors among HIV-infected black patients at primary health care.

METHODS: A cross-sectional screening involving consecutive HIV-infected patients 18 years and older was done. Eighty-eight percent of patients were receiving highly active antiretroviral therapy (94% on first-line regimen: zidovudine + lamivudine + nevirapine). Simplified Modification of Diet in Renal Disease Study and Cockroft-Gault (CG) equations were used to estimate glomerular filtration rate and creatinine clearance, respectively. Determinants of dipstick proteinuria and low kidney function (<60 mL•min(-1)•1.73 m(-2)) were assessed using multivariate logistic regression analysis.

RESULTS: Three hundred HIV-infected (231 females) patients were screened. Their mean age, duration of HIV, and CD4(+) count were 43 ± 9 years, 33 ± 27 months, and 397 ± 224 cells per cubic millimeter, respectively. The prevalence of low eGFR according to Modification of Diet in Renal Disease Study and CG equations was 3% and 10%, respectively. Proteinuria was observed in 20.5% of patients. Only CD4(+) cell count ≤200 cells per cubic millimeter emerged as a strong determinant of low CG creatinine clearance [adjusted odds ratio (OR) 3.03; 95% confidence interval (CI): 1.099 to 8.352], whereas age ≥45 years (adjusted OR 3.69; 95% CI: 1.756 to 7.787), familial history of diabetes mellitus (adjusted OR 2.20; 95% CI: 1.067 to 4.543), and hypertension (adjusted OR 3.07; 95% CI: 1.278 to 7.787) were significantly associated with proteinuria.

CONCLUSIONS: Low eGFR and proteinuria are prevalent among these HIV-infected persons. Immunodeficiency emerged as one of the strongest determinants of renal impairment. This finding emphasizes the importance of highly active antiretroviral therapy in tackling the burden of chronic kidney disease in African HIV population. PMID: 21926635 [PubMed – indexed for MEDLINE]

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