title: High prevalence of renal dysfunction and association with risk of death amongst HIV-infected Ghanaians.
abstract: OBJECTIVE
  To determine the prevalence of HIV-associated renal dysfunction (RD), identify risk factors for RD and explore the association between baseline renal function and mortality in an HIV-infected population in Ghana.
  
  
  METHODS
  Creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR) was calculated in patients attending an HIV clinic between 2004 and 2011 using Cockcroft-Gault, MDRD and CKD-EPI formulae. Logistic regression analysis was used to identify risk factors associated with RD and Kaplan-Meier/Cox proportional regression analyses to explore associations between baseline CrCl/eGFR and subsequent mortality.
  
  
  RESULTS
  In 3137 patients starting antiretroviral therapy (ART) the frequency (95%-CI) of RD, defined by CrCl <60 ml/min/1.73 m(2) using Cockroft-Gault formula was 38.8% (37.1-40.5%). RD prevalence in a sub-population of 238 patients, including proteinuria in the definition, was 15.3% (10.3-22.1%) in ART-treated and 43.6% (34.0-53.7%) in ART-naïve patients. RD at baseline was associated with increasing age, low CD4 counts, advanced WHO stage and female gender. Cox proportional hazard analysis identified an increased hazard of death with decreasing CrCl, HR 1.46 (1.31-1.63) for each tertile lower than CrCl of 90 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  RD is very common in HIV-infected ART-naïve Ghanaians, and associated with increased risk of mortality. Screening and monitoring of RD is important in this setting, particularly as tenofovir use increases.
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Fred S
authors.initials: FS
authors.lastname: Sarfo
authors.forename: Rosie
authors.initials: R
authors.lastname: Keegan
authors.forename: Lambert
authors.initials: L
authors.lastname: Appiah
authors.forename: Shaid
authors.initials: S
authors.lastname: Shakoor
authors.forename: Richard
authors.initials: R
authors.lastname: Phillips
authors.forename: Betty
authors.initials: B
authors.lastname: Norman
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hardy
authors.forename: George
authors.initials: G
authors.lastname: Bedu-Addo
authors.forename: Lydia
authors.initials: L
authors.lastname: Longstaff
authors.forename: David R
authors.initials: DR
authors.lastname: Chadwick
mesh_terms: D000328:Adult; D005260:Female; D005869:Ghana / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D016019:Survival Analysis