Kidney dysfunction and its associated factors among people living with HIV on antiretroviral therapy in rural Rwanda: a cross-sectional study

Abstract

People living with HIV (PLHIV) have a higher risk of developing stage 3–5 of Chronic Kidney Disease (CKD) and this risk is further impacted by the use of antiretrovirals including Tenofovir disoproxil fumarate (TDF), a commonly used antiretroviral throughout SSA. Although, routine renal function testing amongst PLHIV is recommended and integrated into HIV and Non-Communicable Diseases (NCD) national guidelines, the implementation of these guidelines among PLHIV in Rwanda remains a challenge. This study assesses the prevalence of proteinuria and stage 3–5 CKD and its associated risk factors among PLHIV on long-term Tenofovir disoproxil fumarate (TDF) antiretroviral therapy (ART) in Kayonza district, Rwanda. A cross-sectional study was conducted among PLHIV in Kayonza district, rural Rwanda from April 2023 to October 2023. Urine and blood were collected to test for proteinuria and creatinine. Estimated Glomerular Filtration rate (eGFR) was calculated from serum creatinine using the CKD-Epi formula. Sociodemographic and clinical characteristics were summarized as frequencies and percentages. A chi-square or Fisher’s exact test was used to assess the associations between sociodemographic and clinical characteristics with proteinuria and stage 3–5 CKD. A logistic regression model was performed to determine the predictors of proteinuria and CKD at a significance level of < 0.05. This study included 1,302 participants, of whom 79.5% (n = 1,034) were aged between 35 and 65 years and 71.2% (n = 928) were female. The majority (84.4%, n = 1,036) were on TDF-based therapy. Proteinuria was observed in 46.8% (n = 610) of participants, while the overall prevalence of stage 3–5 CKD was 2.6% (n = 34). TDF-based therapy (aOR = 1.6, 95% CI: 1.1–2.2) and random blood glucose > 200 mg/dl (aOR = 4.60, 95% CI: 1.2–16.5) were significant predictors of renal dysfunction. For CKD, being aged 50 and above (aOR = 8.7, 95% CI: 3.0–25.0) and female gender (aOR = 7.1, 95% CI: 2.1–23.8, p = 0.001) were significant predictors of CKD. We found a low prevalence of stage 3–5 CKD among people living with HIV in Kayonza district, but with a high prevalence of proteinuria. TDF-based therapy and high blood glucose levels were significantly associated with proteinuria. Proteinuria is an early marker for renal dysfunction in HIV patients on TDF-based regimens. Our findings highlight the need for implementing guidelines that enhance routine proteinuria testing and eGFR estimation along with blood glucose monitoring at the early stages of treatment.