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 hyperten-
sion. Conversely, proteinuria was unexpectedly infre-
quent in this population. Utilizing resources to assess
renal function prior to initiation of antiretrovirals
in order to identify those likely to benefit from dosage
adjustment is justified.
