Prevalence of Chronic Kidney Disease in ART-Naïve Patients in Southern Nigeria: Need for Creatinine Assay

Abstract

Aims: The current HIV treatment strategy of 'test and start' requires clients diagnosed with HIV to be commenced on antiretroviral therapy (ART) the same day or within one week of HIV diagnosis if possible. However, chronic kidney disease (CKD) is a complication of Human Immunodeficiency Virus (HIV) disease and an adverse event associated with using some antiretroviral drugs (ARDs). The aim of this study was to determine the proportion of ART-naïve patients with serum creatinine assay to assess their kidney functions before the commencement of ART and the prevalence of CKD among them. Study Design:  This was a cross-sectional study. Place and Duration of Study: The study was conducted in an HIV comprehensive treatment centre of a tertiary health facility in southern Nigeria from July to December 2019. Methodology: The medical records of 159 ART-naïve adult patients newly enrolled into HIV care over a six months period were reviewed. Sociodemographic and clinical data were abstracted. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60ml/min/1.732m2.  Results: All the newly enrolled patients were commenced on first-line ARDs. More than half (92,57.9%), were females. The mean age of respondents was 37.3± 10.1 years. Only ninety-one (57.2%) had creatinine assay documented pre-ART commencement, with a similar proportion in males and females (p=0.24). The prevalence of CKD was 15.5% (95% CI: 8.7 - 24.5%) Conclusion: About two out of every five patients had no documented creatinine assay pre-ART commencement.The prevalence of CKD among ART-naïve patients with creatinine assay before the commencement of ARDs  was moderate. A policy change that supports free or subsidized serum creatinine test using point-of-care creatinine machines in all HIV treatment centres to assess kidney function of  HIV patients before ART initiation is recommended.