Chronic Kidney Disease and Associated Factors Among HIV/AIDS Patients on HAART in Ethiopia

Background: In developing countries, both opportunistic infections and chronic diseases account a high HIV-associated mortality and morbidity. Chronic kidney disease (CKD) associated with HIV infection has got increased attention in sub-Saharan Africa as a result of the high HIV prevalence and due to the late diagnosis and initiation of HAART. Thus, this study was conducted to assess CKD and associated factors among HIV patients on HAART in Ethiopia.

Methods: A hospital-based cross-sectional study with a secondary data review was conducted on 336 on HIV/AIDS patients on HAART from February to July 2017 at University of Gondar Referral Hospital. The study participants were selected using a systematic random sampling technique. Socio-demographic and clinical data were collected using a semi-structured questionnaire at their follow-up date with interview and chart review. Three to five milliliters of venous blood and five milliliters of urine specimen were collected for serum creatinine and urine albumin determination, respectively. Data were entered into SPSS version 20 for analysis. Glomerular filtration rate was estimated using the CKD-EPI estimator. Bivariate and multivariate logistic regression was employed and p-value <0.2 and < 0.05, respectively, was considered statistically significant.

Results: The prevalence of CKD on the study participants was 54 (16.1%) (95% CI, 12.2-20.4%). By stage, about 27 (8.0%) had stage 1 (persistent proteinuria with eGFR ≥ 90 mL/min/1.73 m), 16 (4.8%) had stage 2 (persistent proteinuria with eGFR of 60-89.9 mL/min/1.73 m), 6 (1.8%) had stage 3 (eGFR 30-59.9 mL/min/1.73 m with or without proteinuria) and 5 (1.5%) had stage 5 ((kidney failure), eGFR<15mL/min/1.73 m with or without proteinuria). With multivariate logistic regression analysis, being male (AOR=2.05 (1.03-4.09), p=0.04), being merchant (AOR=2.91 (1.00-8.48), p=0.049) and having viral load≥1000 copies/mm (AOR=3.1 (1.38-7.00), P<0.01) were significantly associated with CKD.

Conclusion: The prevalence of CKD among HIV patients on HARRT is high. Being male, merchant and having viral load ≥1000 copies/mm were associated factors of CKD. Patients should be regularly monitored and screened for early diagnosis and management of CKD. Those patients who have being merchant with high viral load and male patients should require close monitoring.