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Nephrology Dialysis Transplantation 2007 22(8):2208-2212; doi:10.1093/ndt/gfm223
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© The Author [2007].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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

Kara Wools-Kaloustian1,2, Samir K. Gupta1, Eva Muloma1, Willis Owino-Ong’or2, John Sidle1,2, Ryan W. Aubrey1, Jianzhao Shen1, Kirwa Kipruto2, Beth E. Zwickl1 and Mitchell Goldman1

1Indiana University School of Medicine, Indianapolis, Indiana, USA and 2Moi University School of Medicine, Eldoret, Kenya

Correspondence and offprint requests to: Dr Mitchell Goldman, Division of Infectious Diseases, Indiana University School of Medicine, Wishard Memorial Hospital (Room OPW 430), 1001 W. 10th Street, Indianapolis, IN 46202, USA. Email: mgoldman{at}iupui.edu



  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.

Keywords: Africa; creatinine clearance; HIV; kidney; proteinuria; renal insufficiency

Received for publication: 23.10.06
Accepted in revised form: 22. 3.07


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