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Citation Information

Type Thesis or Dissertation - Master of Pharmacy
Title Incidence and risk factors of renal dysfunction among HIV positive patients on Nevirapine based regimens at Kenyatta National Hospital
Author(s)
Publication (Day/Month/Year) 2014
URL http://erepository.uonbi.ac.ke/bitstream/handle/11295/76479/Ambetsa_Incidence and risk factors of​renal dysfunction among hiv positive patients on nevirapine based regimens.pdf?sequence=3
Abstract
Introduction
As patients infected with human immunodeficiency virus (HIV) live longer while
receiving antiretroviral therapy, kidney diseases have emerged as significant causes
of morbidity and mortality. Black race, older age, hypertension, diabetes, low CD4+
cell count, and high viral load remain important risk factors for kidney disease in this
population. Chronic kidney disease should be diagnosed in its early stages through
routine screening and clinicians should pay careful attention to changes in
glomerular filtration rate or creatinine clearance. With early detection and treatment,
it is possible to prevent kidney disease and its complications from worsening.
Objectives:
The broad objective of this study was to evaluate the incidence and risk factors of
renal dysfunction in HIV adult patients on Nevirapine based regimens.
Methodology:
This was a descriptive (right censored arm) hospital based retrospective cohort study.
It was carried out at the Kenyatta National Hospital Comprehensive Care Center and
targeted HIV patients on Nevirapine based regimens seen at the KNH-CCC. Data
was collected between May and August 2014. The participants were sampled by
convenient sampling technique. Ethical approval was obtained from the KNH-UoN
Research and Ethics Committee. Quantitative data which was obtained from the
patient interviews and abstraction of patient files was analyzed using STATA version
10 software. Ordered Logistic regression modeling was used to identify covariates
that determine the severity of nephrotoxicity.

Results:
In total, 241 HIV-infected adult patients were included in this study. There were 56
male and185 female patients. The median age was 39 years [IQR 35-44]. The
duration of follow up for most of the patients was 5 years. The prevalence of renal
dysfunction at baseline was 6.3% and the incidence in the study was 4.3%. In this study
xiv
five (2.1%) patients had estimated GFR (eGFR) < 50 mL/min per 1.73 m
2
, while ten
(8.3%) patients had elevated serum creatinine (above 120µg/l). In the multivariate
ordered logistic regression the significant predictor variables for renal dysfunction
that were significant were age at diagnosis, current age at the time of study, the sex,
alcohol consumption and the duration of therapy.
The females had a higher risk of developing renal dysfunction (adjusted O.R 0.48
(95% C.I 0.24-1.04) p=0.04). Alcohol consumption was a significant predictor of
renal dysfunction (adjusted O.R 1.84 (95% C.I 1.01-3.29) p=0.04). Intensity of
alcohol consumption has not been reported as a predictor of renal disease in HIV
patients on HAART. This is the first study to report alcohol use as a risk factor.
Conclusion and Recommendation:
Renal dysfunction might occur in HIV patients on nevirapine based regimens
evidenced by the incidence of 4.3%. The risk factors identified in this study include
age at diagnosis, alcohol consumption, duration of therapy and the female gender.
The elevated serum creatinine level at baseline is a key indicator in the management
of renal dysfunction. Routine eGFR calculations should be done at each clinical visit.
Early detection and vigilant monitoring is required for patients with the known risk
factors; systematic screening and appropriate referrals for kidney disease
management should be advocated for improved patient care. Larger studies
comparing the contribution of other NNRTIs is recommended

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