Renal function and associated mortality risk in adults commencing HIV antiretroviral therapy in Zimbabwe

Abstract

Background:People with HIV (PWH) in sub-Saharan Africa appear to have a higher incidence of renal disease than other global regions but data are limited. This renal impairment may be associated with an increased mortality risk.Aims:To define the prevalence of renal disease and explore its association with mortality risk in a cohort from Zimbabwe commencing antiretroviral therapy (ART) for HIV infection.Methods:A retrospective study of all patients aged at least 18 years, commenced on ART for HIV infection at the Newlands Clinic in Harare, Zimbabwe between January 2007 and September 2019 was conducted. Data were extracted from electronic medical records. Patients with no baseline creatinine measurement were excluded. Baseline characteristics were assessed as potential predictors for mortality by Cox proportional hazard regression.Results:Three thousand and thirty-nine patients were eligible for inclusion. Most were female (62.1%), with a median age of 36 years (IQR 30–43). At baseline, 7.3% had an estimated glomerular filtration rate (eGFR) 90 ml/min per 1.73 m2 or less and 11.4% had proteinuria. Over a median follow-up period of 4.6 years (IQR 2.5–6.9), the mortality rate was 8.7%. One half of deaths (49.2%) occurred within the first year. In multivariable analysis, a baseline eGFR between 60 and 90 ml/min per 1.73 m2 [hazard ratio 2.22, 95% confidence interval (CI) 1.46–3.33, P < 0.001] and proteinuria (hazard ratio 2.10, 95% CI 1.35–3.27, P < 0.001) were associated with increased mortality risk.Conclusion:Baseline renal impairment was common. Both a reduced eGFR or proteinuria were independently associated with a doubling of mortality risk. These should serve as markers in the clinical setting of at-risk patients.

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

“…The proportion of female participants in each study was 40-58%. Three studies recruited participants who were ART-naïve (46, 47, 58), 11 studies recruited ART-experienced participants (6, 33, 44, 45, 48, 51–53, 55–57), and two studies recruited both ART-naïve and ART-experienced participants (49, 50). Three studies recruited only YPLHIV who were perinatally infected (6, 33, 51).…”

“…The most common biomarker used for CKD diagnosis was serum creatinine measured by the enzymatic method. Estimated GFR (eGFR) was used in 13 studies alone and in combination with markers of kidney damage (6, 33, 44–47, 51–53, 55–58). Five studies used an eGFR cut-off of <60ml/min/1.73m 2 (44–46, 55, 57), two used this cutoff alone without any marker of kidney damage (45, 57) and six used a cut-off of <90ml/min/1.73m 2 (6, 33, 47, 51, 53, 58).…”

“…Estimated GFR (eGFR) was used in 13 studies alone and in combination with markers of kidney damage (6, 33, 44–47, 51–53, 55–58). Five studies used an eGFR cut-off of <60ml/min/1.73m 2 (44–46, 55, 57), two used this cutoff alone without any marker of kidney damage (45, 57) and six used a cut-off of <90ml/min/1.73m 2 (6, 33, 47, 51, 53, 58). These studies showed a CKD prevalence between 0.8% and 35.9%.…”

Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review

“…107 It is noteworthy that in Zimbabwe, 44.7% of CKD patients also have severe immunodeficiency upon admission, with a concerning 49.2% mortality rate in a 1-year follow-up, highlighting the critical need for improving understanding and management. 108…”

“…107 It is noteworthy that in Zimbabwe, 44.7% of CKD patients also have severe immunodeficiency upon admission, with a concerning 49.2% mortality rate in a 1-year follow-up, highlighting the critical need for improving understanding and management. 108 Environmental toxins, including contaminated water, air pollution, and pesticides, contribute significantly to CKD in SSA. 109 Genetic predisposition plays a role in CKD, with the APOL1 (apolipoprotein L1) gene as a risk factor for CKD, with 13% of African Americans carrying the APOL1 gene in the United States.…”