title: Renal impairment in a rural African antiretroviral programme.
abstract: BACKGROUND
  There is little knowledge regarding the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment, nor evidence to inform the most cost effective methods of screening for renal impairment. With the increasing availability of the potentially nephrotixic drug, tenofovir, such information is important for the planning of antiretroviral programmes
  
  
  METHODS
  (i) Retrospective review of the prevalence and risk factors for impaired renal function in 2189 individuals initiating antiretroviral treatment in a rural African setting between 2004 and 2007 (ii) A prospective study of 149 consecutive patients initiating antiretrovirals to assess the utility of urine analysis for the detection of impaired renal function. Severe renal and moderately impaired renal function were defined as an estimated GFR of < or = 30 mls/min/1.73 m(2) and 30-60 mls/min/1.73 m(2) respectively. Logistic regression was used to determine odds ratio (OR) of significantly impaired renal function (combining severe and moderate impairment). Co-variates for analysis were age, sex and CD4 count at initiation.
  
  
  RESULTS
  (i) There was a low prevalence of severe renal impairment (29/2189, 1.3% 95% C.I. 0.8-1.8) whereas moderate renal impairment was more frequent (287/2189, 13.1% 95% C.I. 11.6-14.5) with many patients having advanced immunosuppression at treatment initiation (median CD4 120 cells/microl). In multivariable logistic regression age over 40 (aOR 4.65, 95% C.I. 3.54-6.1), male gender (aOR 1.89, 95% C.I. 1.39-2.56) and CD4<100 cells/ul (aOR 1.4, 95% C.I. 1.07-1.82) were associated with risk of significant renal impairment (ii) In 149 consecutive patients, urine analysis had poor sensitivity and specificity for detecting impaired renal function.
  
  
  CONCLUSIONS
  In this rural African setting, significant renal impairment is uncommon in patients initiating antiretrovirals. Urine analysis alone may be inadequate for identification of those with impaired renal function where resources for biochemistry are limited.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa. carafraney@hotmail.co.uk
authors.forename: Cara
authors.initials: C
authors.lastname: Franey
authors.forename: Deborah
authors.initials: D
authors.lastname: Knott
authors.forename: Till
authors.initials: T
authors.lastname: Barnighausen
authors.forename: Martin
authors.initials: M
authors.lastname: Dedicoat
authors.forename: Ahmed
authors.initials: A
authors.lastname: Adam
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lessells
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000652:urine; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology* / Q000652:urine; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D019380:Anti-HIV Agents