High prevalence of renal dysfunction and association with risk of death amongst HIV-infected Ghanaians

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• 作者：Fred S. Sarfo^a ; Rosie Keegan^b ; Lambert Appiah^a ; Shaid Shakoor^b ; Richard Phillips^a ; Betty Norman^a ; Yasmin Hardy^a ; George Bedu-Addo^a ; Lydia Longstaff^b ; David R. Chadwick^b ; ^{davidr.chadwick@stees.nhs.uk}
• 关键词：HIV ; Kidney ; Renal ; Africa ; Antiretroviral therapy
• 刊名：Journal of Infection
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：67
• 期：1
• 页码：43-50
• 全文大小：387 K

文摘

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Summary

Objectives

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 Kaplan-Meier/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 % (37.1-40.5 % ). RD prevalence in a sub-population of 238 patients, including proteinuria in the definition, was 15.3 % (10.3-22.1 % ) in ART-treated and 43.6 % (34.0-53.7 % ) in ART-na?ve 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 (1.31-1.63) for each tertile lower than CrCl of 90?ml/min/1.73?m².

Conclusions

RD is very common in HIV-infected ART-na?ve Ghanaians, and associated with increased risk of mortality. Screening and monitoring of RD is important in this setting, particularly as tenofovir use increases.