Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya.
BACKGROUND
Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because no prospective studies of the prevalence or risk factors for kidney disease in stable outpatient human immunodeficiency virus (HIV)-infected indigenous African populations 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-naïve adults, without diabetes or hypertension, 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 1+, 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 antiretrovirals in order to identify those likely to benefit from dosage adjustment is justified.
Wools-Kaloustian
Kara
K
Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Gupta
Samir K
SK
Muloma
Eva
E
Owino-Ong'or
Willis
W
Sidle
John
J
Aubrey
Ryan W
RW
Shen
Jianzhao
J
Kipruto
Kirwa
K
Zwickl
Beth E
BE
Goldman
Mitchell
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003401:Creatine / Q000652:urine; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D007630:Kenya; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis; D012307:Risk Factors
D044966:Anti-Retroviral Agents; D003401:Creatine