Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya

Kara Wools-Kaloustian, Samir Gupta, Eva Muloma, Willis Owino-Ong'or, John Sidle, Ryan W. Aubrey, Jianzhao Shen, Kirwa Kipruto, Beth E. Zwickl, Mitchell Goldman

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2208-2212
Number of pages5
JournalNephrology Dialysis Transplantation
Volume22
Issue number8
DOIs
StatePublished - Aug 2007

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Kenya
Outpatients
HIV
Renal Insufficiency
Kidney
Population
Kidney Diseases
Proteinuria
Hypertension
Diet Therapy
Population Groups
Developing Countries
Creatinine
Cross-Sectional Studies
Urine
Prospective Studies
Proteins

Keywords

  • Africa
  • Creatinine clearance
  • HIV
  • Kidney
  • Proteinuria
  • Renal insufficiency

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya. / Wools-Kaloustian, Kara; Gupta, Samir; Muloma, Eva; Owino-Ong'or, Willis; Sidle, John; Aubrey, Ryan W.; Shen, Jianzhao; Kipruto, Kirwa; Zwickl, Beth E.; Goldman, Mitchell.

In: Nephrology Dialysis Transplantation, Vol. 22, No. 8, 08.2007, p. 2208-2212.

Research output: Contribution to journalArticle

Wools-Kaloustian, Kara ; Gupta, Samir ; Muloma, Eva ; Owino-Ong'or, Willis ; Sidle, John ; Aubrey, Ryan W. ; Shen, Jianzhao ; Kipruto, Kirwa ; Zwickl, Beth E. ; Goldman, Mitchell. / Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya. In: Nephrology Dialysis Transplantation. 2007 ; Vol. 22, No. 8. pp. 2208-2212.
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AU - Sidle, John

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AU - Shen, Jianzhao

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AB - 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.

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