Kidney function predictors and associated serum electrolytes changes in HIV out patients attending Jaramogi Oginga Odinga teaching and referral hospital, Kisumu county, Kenya

Abstract

Background: Kidney disease has been recognised as one of the health challenges complicating HIV infection, prognosis and management. Early recognition, diagnosis and treatment are therefore key to ameliorating the deleterious impacts of kidney disease in HIV infected patients.

Objectives: To assess serum kidney function markers in order to highlight the state of kidney health and the impact of its functional impairment on other serum electrolytes and body fluids parameters

Design: A case-control study.

Setting: At Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient support centre.

Subjects: Eight Hundred HIV positive and 406 HIV negative participants above 18 years of age.

Results: Mean serum creatinine and urea levels was significantly elevated in HIV – infected individuals than the healthy control group (95.2μmol/l v/s 86.2μmol/l, p<0.0001 and 4.6mmol/l v/s 4.1mmol/l, p<0.0001 respectively). The prevalence of pathological levels of serum creatinine, urea and sodium was higher in HIV-infected patients than HIV-negative participants (26.1% v/s 11.8%, p<0.0001; 4.4% v/s 0.5%, P<0.0001and 26.1% v/s 10.6%, p=0.001 respectively). Females experienced more serum creatinine disorders than their male counterparts (31.8% v/s 18.1%, p<0.0001). Age and antiretroviral treatment were not predictors of aberrations in levels of kidney function markers in HIV infected patients. AIDS defining CD4 depletion was associated with enhanced deterioration of kidney function. However, kidney function anomalies were not sufficient explanation for co-existing electrolyte anomalies as clinically altered creatinine states only correlated and co-varied with urea states (r =0.715) while sodium states co-varied with chloride levels (r = 0.296).

Conclusion: Kidney function disorders are not infrequent in HIV infected individuals. Serum sodium aberration is observed more frequently in seropositive than in seronegative individuals. Routine review of kidney health status in local HIV infected individuals ought to be adopted for comprehensive management of HIV patients, more so among the female gender.