2. RENAL DYSFUNCTION AMONG ADULT HIV/AIDS PATIENTS ON ANTIRETROVIRAL THERAPY AT CAPE COAST TEACHING HOSPITAL, GHANA OBIRI-YEBOAH DORCAS BOTCHWAY ELIZABETH TABITHA AWUKU YAW ASANTE

3. BACKGROUND
There is improvement of survival with widespread use of combined antiretroviral therapy
Kidney Diseases have emerged as significant cause of morbidity and mortality in clients with HIV on ART
TDF has been found to cause decrease in creatinine clearance (Kooij, Vogt et al. 2017)

4. BACKGROUND
The preferred first line regimen given to patients in Ghana is Tenofovir + Lamivudine (or Emtricitabine) and Efavirenz (ART Guidelines, 2016).
Follow up of clients is by estimation of serum creatinine and urea levels
GFR is not routinely calculated and Proteinuria is not routinely checked

5. STUDY OBJECTIVE
To determine the serum concentration of creatinine, urea; urine protein and to grade the stage of the renal dysfunction among adult HIV/AIDS patients who are on ART based on GFR estimation at the Cape Coast Teaching Hospital , Ghana

6. METHODOLOGY
Hospital-based Analytical cross sectional study with a retrospective component
Systematic Sampling of Clients with HIV/AIDS who visited the ART Clinic
440 participants of both sexes aged 18 years and above were involved in the study
Blood and urine samples were collected from all subjects
Levels of serum creatinine, urea and proteinuria were estimated

7. METHODOLOGY Sociodemographic data were obtained
Retrospective data of WHO Clinical Staging before the initiation of ART, duration of ART, baseline CD4 Count, current CD4 Count, Plasma Viral Load(6 months and one year where applicable)
eGFR was calculated using the Modification od Diet in Renal Disease (MDRD) equations.

8. RESULTS AND DISCUSSION
Variable
Mean (SD)/Median (IQR)/n (%)
Age (yrs.)
Mean
45.5 (±11.6)
18-30
38 (8.6)
31-60
367 (83.4)
>60
35 (8.0)
Gender
Male
94 (21.4)
Female
346 (78.6)
Last WHO clinical stage
1 and 2
122 (27.7)
3 and 4
318 (72.3))
ART regimen
TDF based regimen
288 (65.5)
Non-TDF based regimen
152 (34.5)

9. Variable
Mean (SD)//n (%)
Baseline Creatinine levels, µmol/l (N=425)
Mean value
72.4 (±31.7)
Normal values
412 (96.9)
High values
13 (3.1)
Blood creatinine after 6 months on ART, µmol/l (N=391)
75.9 (±25.3)
373 (95.6)
17 (4.4)
Current Creatinine levels, µmol/l (N=387)
80 (±56.6)
380 (98.2)
7 (1.8)

10. RESULTS AND DISCUSSION – ESTIMATED GFR

11. RESULTS AND DISCUSSION – URINE PROTEIN

12. Variable
eGFR <90, {n (%)}
OR (95%CI)
p-value
#OR (95%CI)
Age (years)
18-30
10 (5.4) -
31-60
154 (82.6)
2.1 ( )
0.048
2.4 ( )
0.026
>60
22 (12.0)
5.9 ( )
0.001
7.1( )
Gender
Male
24 (13.0)
Female
160 (87.0)
2.5 ( )
2.7 ( )

13. RESULTS AND DISCUSSION – CKD STAGE USING eGFR
Variable
Mean (SD)//n (%)
Current eGRF(ml/min/1.73 m)
≥90 (CKD stage 1)
203 (52.4)
60-89 (CKD stage 2)
164 (42.4)
30-59 (CKD stage 3)
18 (4.7)
15-29 (CKD stage 4)
2 (0.5)
<15(CKD stage 5)
0 (0.0)

14. RESULTS AND DISCUSSION
Pathogenesis of CKD among PLWH is Multifactorial
At recruitment, 94.8% of study participants had eGFR>60ml/min/1.73m2
Good opportunity for education and intervention to slow down progression to ESKD
Factors that may cause CKD in PLWH –
Nephrotoxic antiretroviral medication
HIV Viraemia
Chronic systemic inflammation
Others: Hypertension, DM, Smoking

15. RESULTS AND DISCUSSION
Proteinuria was detected in 30.9% of overall study participants whilst only 1.8% had abnormal creatinine values
Use of creatinine always lags behind in the identification of early renal disease.
By the time creatinine rises, the disease may be late.
Use of ESTIMATED GFR is a better index used in addition to Proteinuria.
Measures can be instituted at this time
ART Clinics routinely use creatinine to identify renal disease

16. RESULTS AND DISCUSSION
Tenofovir Based Regimen was not associated with CKD among the clients (65.4% were on TDF based Regimen)
Possible switch of regimen when renal dysfunction is detected
This study reports that after adjusting for confounders including being on TDF based ART regimen, age group had odds of 2.4 (95% CI: ), age >60years had 7.1(95%CI: ) and the gender female (2.7 odds) have a significant association with eGFR <90.
Traditionally TDF based Regimen adverse effect is reported as AKI instead of CKD

17. CONCLUSION
Estimated GFR progressively decreases over time among patients on ART despite normal serum creatinine and urea levels
Makes it expedient that HIV/ART clinics in Ghana introduce routine estimation of eGFR and proteinuria among all clients for early screening and diagnosis

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