J HERON1, T SHAMU2,3, C CHIMBETETE2, R DAHWA4, D GRACEY1,5
1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia, 2Newlands Clinic, Harare, Zimbabwe, 3Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland, 4Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, 5Central Clinical School, University of Sydney, Sydney, Australia
Background: Renal dysfunction is common amongst people living with HIV (PLWHIV). Risk factors for kidney disease including obesity, diabetes and hypertension are also prevalent. There are no data on the prevalence of renal impairment or proteinuria among PLWHIV commencing antiretroviral therapy (ART) in Zimbabwe.
Methods: A retrospective cohort study of adult treatment-naïve PLWHIV commencing ART from Jan-2010 to Jan-2019 at Newlands Clinic, Harare. Baseline and 6-month follow-up data were extracted from the electronic medical record. Estimated glomerular filtration rate (eGFR) was calculated using the CKI-EPI equation. Proteinuria was determined by dipstick.
Results: Among 1,598 patients the mean baseline serum creatinine was 68.6umol/L and mean baseline eGFR was 123.6ml/min/1.73m2. 293 patients (18.3%) had a history of hypertension, 40 patients (2.5%) had a history of diabetes and 613 (41.8%) patients were overweight. 104 patients (8.7%) had proteinuria at baseline. Moderate renal impairment (eGFR<60ml/min/1.73m2) was present in 33 patients (2.1%). After 6-months of ART the mean eGFR increased to 125.3ml/min/1.73m2 (p<0.001) and the prevalence of proteinuria fell to 5.0% (p<0.001). In multiple regression analysis change in eGFR (adjusted R2 0.314) was related negatively to hypertension (b=-2.291, p=0.042) and age (b=-0.722, p=<0.001). Change in eGFR (adjusted R2 0.02) was related positively to BMI>30kg/m2 (b= 3.028, p=0.021) but not after adjusting for baseline variables. In logistic regression analysis proteinuria at 6-months was predicted by baseline proteinuria (OR5.704, 95%CI3.16-10.294; p<0.001) and hypertension (OR1.864, 95%CI1.038-3.348; p=0.037).
Conclusions: In a cohort of comorbid ART-naïve PLWHIV in Harare, renal impairment was uncommon. Renal function improved after 6-months of ART. Proteinuria was common and fell in prevalence after 6-months of ART. Hypertension was common and predicted poorer renal function and proteinuria after 6-months of ART.
Jack Heron is an Advanced Trainee in Nephrology at Royal Prince Alfred Hospital and Liverpool Hospital.