Renal Function Among ART-Naive, HIV-Infected Patients
Ethical approval was obtained from the research and ethical committee of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu.
In this cross-sectional study, patients with confirmed HIV infection, with no previously documented risk factors for renal insufficiency, were consecutively recruited and studied over a 1-year period. Study participants included patients presenting for the first time at the HIV clinic of the UNTH Ituku Ozalla, a referral center that receives patients from south eastern and south—south states of Nigeria. All patients were ART naive and aged 18 years and older.
Patients with conditions known to be associated with kidney abnormalities, sickle cell disease, acute infection, pregnancy, previously diagnosed diabetes, systemic hypertension, or previously known renal disease were excluded.
Baseline medical information was obtained from eligible patients using a structured pretested questionnaire. Information on HIV-associated conditions was also obtained. Blood pressure, weight, and height were documented, and CD4 count (Roche Monitor 1.5 test kit; Becton-Dickinson FACS Count), hemoglobin, blood urea nitrogen, creatinine (fixed time kinetic assay by Human) were obtained. Serum electrolytes and viral load were also carried out at this first contact.
Creatinine clearance was calculated using the Cockroft and Gault (CG) formula, which studies have shown to be comparable to other formulae for estimating estimated glomerular filtration rate (eGFR) in HIV-infected patients.
Clinical guidelines from the US National Kidney Foundation's Kidney Disease Outcome Quality Initiative (K/DOQI) to categorize renal insufficiency were used to grade renal impairment. Creatinine clearance of >90 mL/min per 1.73 m was considered normal; creatinine clearance of 60 to 89 mL/min per 1.73 m (K/DOQI stage 2) was categorized as mild renal insufficiency; 30 to 59 mL/min per 1.73 m as moderate insufficiency (K/DOQI stage 3); and <30 mL/min per 1.73 m as severe insufficiency (K/DOQI stages 4 and 5). For the purposes of this study, GFR of below 60 mL/min per 1.73 m was used as the cutoff point for significant renal impairment.
Data were analyzed using the Statistical Package for the Social Sciences version 15. Independent sample t test was used to compare the means of variables, and Pearson chi-square cross-tabulation was used to test the significance of association. Correlation statistics was also done to test the associations. Risk factors for renal impairment were determined with binary logistic regression. Significant renal impairment (defined above) was the outcome variable. Results were expressed as mean (standard deviation [SD]). P values <.05 were considered significant.
Methods
Ethical approval was obtained from the research and ethical committee of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu.
In this cross-sectional study, patients with confirmed HIV infection, with no previously documented risk factors for renal insufficiency, were consecutively recruited and studied over a 1-year period. Study participants included patients presenting for the first time at the HIV clinic of the UNTH Ituku Ozalla, a referral center that receives patients from south eastern and south—south states of Nigeria. All patients were ART naive and aged 18 years and older.
Patients with conditions known to be associated with kidney abnormalities, sickle cell disease, acute infection, pregnancy, previously diagnosed diabetes, systemic hypertension, or previously known renal disease were excluded.
Baseline medical information was obtained from eligible patients using a structured pretested questionnaire. Information on HIV-associated conditions was also obtained. Blood pressure, weight, and height were documented, and CD4 count (Roche Monitor 1.5 test kit; Becton-Dickinson FACS Count), hemoglobin, blood urea nitrogen, creatinine (fixed time kinetic assay by Human) were obtained. Serum electrolytes and viral load were also carried out at this first contact.
Creatinine clearance was calculated using the Cockroft and Gault (CG) formula, which studies have shown to be comparable to other formulae for estimating estimated glomerular filtration rate (eGFR) in HIV-infected patients.
Clinical guidelines from the US National Kidney Foundation's Kidney Disease Outcome Quality Initiative (K/DOQI) to categorize renal insufficiency were used to grade renal impairment. Creatinine clearance of >90 mL/min per 1.73 m was considered normal; creatinine clearance of 60 to 89 mL/min per 1.73 m (K/DOQI stage 2) was categorized as mild renal insufficiency; 30 to 59 mL/min per 1.73 m as moderate insufficiency (K/DOQI stage 3); and <30 mL/min per 1.73 m as severe insufficiency (K/DOQI stages 4 and 5). For the purposes of this study, GFR of below 60 mL/min per 1.73 m was used as the cutoff point for significant renal impairment.
Statistical Analysis
Data were analyzed using the Statistical Package for the Social Sciences version 15. Independent sample t test was used to compare the means of variables, and Pearson chi-square cross-tabulation was used to test the significance of association. Correlation statistics was also done to test the associations. Risk factors for renal impairment were determined with binary logistic regression. Significant renal impairment (defined above) was the outcome variable. Results were expressed as mean (standard deviation [SD]). P values <.05 were considered significant.
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