A Study on Estimated Glomerular Filtration Rate As A Predictor of Renal Dysfunction Among Adult Hiv Patients on Highly Active Antiretroviral Therapy
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 10
Abstract
Intoduction: Renal dysfunction is the common complication of HIV infection with a prevalence of 30 % in HIV patients. The spectrum of renal dysfunction is multifactorial ranging from exacerbation of chronic kidney disease to acute kidney injury. Kidney disease in the setting of HIV can pose a significant challenge to patients and clinicians by increasing the risk for AIDS- defining illness, hospitalization and death. Objectives: The prevalence of renal dysfunction among HIV-1 infected outpatients starting ART therapy in India is limited. Recent recommendation to include the Nephrotoxic drug tenofovir in the first-line ART regimens make clarification of this issue urgent. Methodology: We screened for renal dysfunction by measuring serum creatinine, urea, microalbuminuria, USG-KUB, low CD-4 counts and opportunistic infections inn HIV- positive patients initiating ART at Coimbatore Medical College Hospital. We excluded patients with preexisting renal disease, hypertension, diabetes, pregnancy, Hepatitis B/C virus co infection. eGFR were calculated using the Cockcroft-gault equation and categorized based on Nation kidney disease foundation staging of Chronic Kidney Disease. eGFR calculated at the end of the study was compared with Age, Gender, Weight, CD4 counts, Urea, Creatinine and with different types of ART regimen used by the study population. Results: Only 21 of the enrolled patients had normal eGFRabove 90ml/min/1.73m2 ( Grade-0 or 1) . Grade 2 was present in 37 and 42 had grade 3 dysfunction or less. Microalbuminuria was detected in 47 % of patients. Mean eGFR was 68.28 . 70 % of patients fall under Tenofovir based regimen. Of which 64% patients fall in eGFR< 90 ml/min and in particular 38% falls under eGFR< 60ml/min which indicates moderate to severe renal dysfunction. Conclusion: Renal dysfunction was highly prevalent in this population of HIV positive out patients initiating first ART in Coimbatore medical college hospital. This highlights the critical and underappreciated need to monitor renal function in HIV – positive patients, particularly given the increasing use of tenofovir in first line ART
Authors and Affiliations
Dr. N. Karuppusamy m. d, Dr. p. vishnu ram m. d, Dr. K. Gayathri, Dr. Srinivasan karthikeyan
Keywords
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- EP ID EP244372
- DOI 10.9790/0853-1610092834
- Views 72
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