The aim of this study was to assess the prevalence of CKD among HIV/AIDS patients and its associated factors.
Study area, design, and population
A hospital-based cross-sectional study was conducted from February 01, to April 30, 2017 at the University of Gondar Referral Hospital (UOGRH), which is located in the North Gondar zone, 747 km from the capital city of the country, Addis Ababa. Gondar has an estimated population of more than 206,987 (98,085 males and 108,902 females) based on the 2008 central statistical agency data. at the time of data collection, there were about 13753 HIV patients and 5389 HIV patients on HAART.
Adult HIV/AIDS patients who received HAART in UOGRH were the study population. Those adult HIV/AIDS patients who received HAART for more than 6 months, visited UOGRH during the study period and consented to be involved in the study were included in the study. Whereas, patients who were seriously sick; and unable to give response, diabetic, and hypertension were excluded from the study. In addition, patients with incomplete laboratory and clinical data such as: baseline adherence, baseline drug regimen, HIV/AIDS WHO stage, weight, etc. were excluded from study.
Sample size determination and sampling technique
Based on single population formula and systematic random sampling technique with the following assumption, P = population proportion (estimated prevalence) = 0.5 to yield maximum sample size, precision d, 0.05, by assuming 95% confidence interval α = 0.05 and z (1-a/2) = 1.96was used for sample size determination. Including 10% non response rate, the final sample size was 423. However, a total of 336 HIV patients on HARRT participated in the study (Fig. 1).
During the three-month data collection period, 1320 HIV/AIDS patients on HAART (> 6 months) were expected to visit the hospital for follow up. The average number of HIV/AIDS patients per day under follow up was 20 sampling intervals (K value) was calculated with 1320/423 = 3.12 = 3. Thus interviews, chart review and blood and urine specimen collection for chemistry analysis and urine dipstick were conducted at 3 intervals. To determine the first-person, the lottery method was used at 1st day from the 20 patients who had under follow up. Then each 3rd client was selected for interview, chart review and blood chemistry and urine dipstick test. If the 3rd patient is not fulfilling the inclusion criteria; the next person was taken as a study subject.
Data collection and laboratory methods
Socio-demographic characteristics and clinical data were collected by trained nurses using a semi-structured questionnaire. The patient individual chart was also reviewed for relevant information. Variables included age, gender, residence, education, occupation, viral load, CD4 count, co-infections, base line CD4 + count, regimen type, WHO stage, duration of follow up time, etc.
About 3–5 ml of venous blood was collected aseptically from the patients and serum was separated after the sample clotted and centrifuged at 1000–2000 g for 10 minutes by trained laboratory technologist. A serum sample was immediately separated from the whole blood and transferred to nunc tube. The serum was kept frozen at -20 ºC until processed. A serum creatinine level was determined using Mindray BS-200 chemistry analyzer (Shenzhen Mindray Bio-Medical Electronics Co. Ltd, China) and reported in mg/dL. About 5 ml of urine specimen was collected using clean, dry and leak proof urine cup for urine protein level determination. Chemical analysis of urine specimens was performed immediately after sample collection using urine dipsticks test (Multistix® Henry Schein, Inc.https://www.henryschein.com/medical-multistix.aspx). Urine protein level was reported semi-quantitatively as negative, or + 1, to + 4. Glomerular filtration rate (GFR) was estimated using CKD–EPI question.Chronic kidney disease was defined using eGFR and presence of albuminuria and classified into five stages according to the classification of Kidney Disease Improving Global Outcomes (KDIGO).
Chronic kidney disease is defined as abnormalities of kidney structure or function, present for ≥ 3 months, with implications for health and CKD is classified based on cause, GFR category, and proteinuria category .
- Stage 1, persistent proteinuria with eGFR ≥ 90 ml/min/1.73 m2
- Stage 2, persistent proteinuria with eGFR of 60-89.9 ml/min/1.73 m2
- Stage 3, eGFR 30-59.9 ml/min/1.73 m2 with or without proteinuria
- 3A (eGFR 45–59.9ml/min/1.73 m2)
- 3B (eGFR 30–44.9ml/min/1.73 m2)
- Stage 4, eGFR 15-29.9 ml/min/1.73 m2 with or without proteinuria
- Stage 5, (kidney failure), eGFR<15ml/min/1.73 m2 with or without proteinuria.
HAART experienced: taking HAART for more than 6 months which is composed of two NRTIs plus an NNRTI .
Underweight, normal weight, overweight and obesity was defined as a BMI < 18.5 kg/m2, 18.5–24.9 kg/m2, 25-29.9 kg/m2 and ≥ 30 kg/m2, respectively .
Hypertension: defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or taking medication for blood pressure-lowering .
Adherence: adherence was calculated as No of the dose of HAART taken / No of prescribed doses of HAART x 100%. Good adherence, > 95%, fair adherence, 85–95% and poor adherence, < 85% doses take[33, 34].
Data processing and analysis
The completeness of the data was checked and entered into SPSS version 20 for analysis. During analysis, descriptive statistics such as percentage, mean and standard deviation were used. Bivariate logistic regression was used to assess the crude association between independent and dependent variables, and with p-value ≤ 0.20 were considered for multivariate logistic regression. Finally, logistic regression was used to identify independent predictors of CKD and p-value < 0.05 was considered statistically significant.