Renal disease in an antiretroviral-naı¨ve HIV-infected outpatient population in Western Kenya

Abstract

Background. Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because no pro spective studies of the prevalence or risk factors for kidney disease in stable outpatient human immunode ficiency virus (HIV)-infected indigenous African popu lations have been published to date, it is not known if already scarce resources should be allocated to detect renal dysfunction, in those without risk factors for kidney disease, prior to initiation of increasingly available antiretrovirals in developing countries. Methods. A cross-sectional study to determine the prevalence of and risk factors for renal disease in a cohort of medically stable, HIV-infected, antiretroviral-naı¨ve adults, without diabetes or hyper tension, presenting to an HIV clinic in western Kenya. Results. Of 373 patients with complete data, renal insufficiency (CrCl <60 ml/min) was identified in 43 (11.5%) [18 (4.8%) had a CrCl <50 ml/min]. Despite high correlation coefficients between the three renal function estimating equations used, when compared to creatinine clearance as calculated by Cockcroft–Gault, lower rates of moderate to severe renal insufficiency were identified by the Modification of Diet in Renal Disease equations. Proteinuria, defined as a urine dipstick protein of equal to or greater than 1þ, was detected in only 23 subjects (6.2%). Conclusions. Renal insufficiency is not uncommon, even in stable patients without diabetes or hypertension. Conversely, proteinuria was unexpectedly infrequent in this population. Utilizing resources to assess renal function prior to initiation of anti retrovirals in order to identify those likely to benefit from dosage adjustment is justified.