Prevalence of chronic kidney disease in HIV positive patients in Lagos, south-west Nigeria

The human immunodeficiency virus (HIV) pandemic is one of the leading causes of death in the developing world. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with HIV are major causes of morbidity and mortality in HIV-positive patients. This cross-sectional study was conducted to determine the prevalence and risk factors of CKD in HIV-positive, antiretroviral naïve patients at a single HIV clinic in Lagos, Nigeria. Of 402 patients, CKD was observed in 23.5% while among 146 controls, CKD was detected in 5.5% (odds ratio (OR) 5.34 [95% CI 2.4–12.2]; P<0.0001). Macroalbuminuria was seen in 20.1% of patients and 2.1% of controls, (OR 12 [95% CI 3.7–38.5]; P<0.0001). Most of the patients and controls were categorized into CKD stages 1 and 2, none among the control was in stage 4 or 5 CKD, while 2 and 2.2% of patients were in stages 4 and 5, respectively (P=0.005). Macroalbuminuria (P<0.0001) and HIV RNA viral load (P=0.010) correlated with CKD on multivariate linear regression analysis. Macroalbuminuria may, therefore, be a useful marker of degree of CKD in HIV seropositive patients. To reduce the burden of CKD and ESRD in populations with high prevalence of HIV, there is a need for increased screening and surveillance for CKD through performance of simple tests to estimate protein in the urine. One of the limitations of this is in using the abbreviated Modification of Diets in Renal Disease (MDRD) equation for estimating glomerular filtration rate.