Impaired Renal Function and its Predictors among Treatment-Naive HIV-seropositive Patients in a Tertiary Institution in South-East Nigeria

BACKGROUND: Renal impairment is a significant independent risk factor for mortality among HIV-infected patients. Some antiretroviral drugs are nephrotoxic, especially to the tubules, and their dosage need to be modified in the presence of renal impairment to avoid progression to chronic kidney disease. AIM: To determine the prevalence and predictors of renal impairment among treatment-naïve HIV sero-positive patients seen at Federal Medical Centre, Umuahia, Abia state. MATERIALS AND METHODS: This was a cross-sectional study involving 115 HIV-seropositive treatment-naïve cases and 115 seronegative controls. Questionnaires were administered and history regarding health status was obtained. Participants had biophysical profile measured. Blood and urine specimens were analyzed in the laboratory. The re-expressed modification of diet in renal disease (MDRD) was used to determine estimated Glomerular Filtration Rate (eGFR). Factors found to be associated with renal impairment were subjected to binary logistic regression analysis to determine the predictors of renal impairment. RESULTS: The prevalence of renal impairment among the cases was 27.8%. Factors associated with renal impairment included duration of HIV diagnosis of 12 months and above, significant intake of herbal remedies, hypertension, significant proteinuria, WHO clinical stage 3 or 4, anaemia and CD4 count less than 350cells/µL. Predictors of renal impairment were hypertension, WHO clinical stage 3 or 4 disease, significant proteinuria and significant intake of herbal remedies. CONCLUSION: Renal impairment was prevalent in this sample. Concerted efforts should be directed to early diagnosis of renal impairment among these patients. Reno-protective measures need to be instituted early to avoid deleterious outcomes.