Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
PLoS One. 2021 Jan 22;16(1):e0245500. doi: 10.1371/journal.pone.0245500. eCollection 2021.
To evaluate the prevalence and associated factors of abnormal renal function among Ethiopian HIV-infected patients at baseline prior to initiation of antiretroviral therapy (ART) and during follow-up.
We conducted a retrospective observational cohort study of HIV infected patients who initiated ART at the outpatient ART clinic of Mehal Meda Hospital of North Shewa, Ethiopia from January 2012 to August 2018. Demographic and clinical data were abstracted from the medical records of patients. Renal function was assessed by estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Univariate and multivariate analysis were conducted to determine the factors associated with abnormal renal function at baseline and during follow-up.
Among 353 patients, 70 (19.8%) had baseline eGFR <60 ml/min/1.73m2 and 102 (28.9%) had eGFR = 60-89.9 ml/min/1.73m2. Factors associated with baseline renal impairment (eGFR <60 ml/min/1.73m2) included female sex (AOR = 3.52, CI 1.75-7.09), CD4 count < 200 cells/mm3 (AOR = 2.75, CI 1.40-5.42), BMI < 25 Kg/m2 (AOR = 3.04, CI 1.15-8.92), low hemoglobin (AOR = 2.19, CI 1.16-4.09) and high total cholesterol (AOR = 3.15, CI 1.68-5.92). After a median of 3.0 years of ART, the mean eGFR declined from 112.9 ± 81.2 ml/min/1.73m2 at baseline to 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001). The prevalence of renal impairment increased from 19.8% at baseline to 22.1% during follow-up. Of 181 patients with baseline normal renal function, 49.7% experienced some degree of renal impairment. Older age (AOR = 3.85, 95% CI 2.03-7.31), female sex (AOR = 4.18, 95% CI 2.08-8.40), low baseline CD4 (AOR = 2.41, 95% CI 1.24-4.69), low current CD4 count (AOR = 2.32, 95% CI 1.15-4.68), high BMI (AOR = 2.91, 95% CI 1.49-5.71), and low hemoglobin (AOR = 3.38, 95% CI 2.00-7.46) were the factors associated with renal impairment during follow-up.
Impaired renal function was common in HIV-infected patients initiating ART in an outpatient setting in Ethiopia, and there appears to be a high prevalence of renal impairment after a median ART follow-up of 3 years. There is a need for assessment of renal function at baseline before ART initiation and regular monitoring of renal function for patients with HIV during follow-up.
评估在开始抗逆转录病毒治疗 (ART) 之前和随访期间，埃塞俄比亚 HIV 感染患者中肾功能异常的患病率及其相关因素。
我们对 2012 年 1 月至 2018 年 8 月期间在埃塞俄比亚北舍瓦 Mehal Meda 医院门诊 ART 诊所开始接受 ART 的 HIV 感染患者进行了回顾性观察队列研究。从患者的病历中提取人口统计学和临床数据。通过使用肾脏病饮食改良公式 (MDRD) 计算估计肾小球滤过率 (eGFR) 来评估肾功能。进行单变量和多变量分析以确定基线和随访期间与肾功能异常相关的因素。
在 353 名患者中，70 名 (19.8%) 在基线时 eGFR <60 ml/min/1.73m2，102 名 (28.9%) 时 eGFR = 60-89.9 ml/min/1.73m2。与基线肾功能损害 (eGFR <60 ml/min/1.73m2) 相关的因素包括女性 (AOR = 3.52，95%CI 1.75-7.09)、CD4 计数 < 200 个细胞/mm3 (AOR = 2.75，95%CI 1.40-5.42)、BMI < 25 Kg/m2 (AOR = 3.04，95%CI 1.15-8.92)、低血红蛋白 (AOR = 2.19，95%CI 1.16-4.09) 和高总胆固醇 (AOR = 3.15，95%CI 1.68-5.92)。在接受中位数为 3.0 年的 ART 后，平均 eGFR 从基线时的 112.9 ± 81.2 ml/min/1.73m2 下降到 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001)。肾功能损害的患病率从基线时的 19.8%增加到随访期间的 22.1%。在基线肾功能正常的 181 名患者中，有 49.7%的患者出现不同程度的肾功能损害。年龄较大 (AOR = 3.85，95%CI 2.03-7.31)、女性 (AOR = 4.18，95%CI 2.08-8.40)、基线时 CD4 计数较低 (AOR = 2.41，95%CI 1.24-4.69)、当前 CD4 计数较低 (AOR = 2.32，95%CI 1.15-4.68)、BMI 较高 (AOR = 2.91，95%CI 1.49-5.71) 和低血红蛋白 (AOR = 3.38，95%CI 2.00-7.46) 是随访期间肾功能损害的相关因素。
在埃塞俄比亚的门诊环境中，开始接受 ART 的 HIV 感染患者中肾功能损害很常见，在中位数为 3 年的 ART 随访后，似乎有很高的肾功能损害患病率。在开始 ART 之前需要评估基线肾功能，并在随访期间定期监测 HIV 患者的肾功能。
