A Study on Estimated Glomerular Filtration Rate (eGFR) as a Predictor of Renal Dysfunction among Adult HIV Patients on Highly Active Antiretroviral Therapy (HAART)

Gayathri, K (2015) A Study on Estimated Glomerular Filtration Rate (eGFR) as a Predictor of Renal Dysfunction among Adult HIV Patients on Highly Active Antiretroviral Therapy (HAART). Masters thesis, Coimbatore Medical Collegel, Coimbatore.


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INTRODUCTION: 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 in India is limited. Recent recommendations to include the Nephrotoxic drug Tenofovir in 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 CD4 counts and Opportunistic infections in HIV-positive patients initiating ART at Coimbatore Medical College Hospital. We excluded patients with preexisting renal disease, hypertension, diabetes, pregnancy or Hepatitis B/ C virus co-infection. eGFR were calculated by Cockcroft-Gault Equation, and eGFR was categorized accordingly based on National Kidney Foundation staging of Chronic Kidney disease : < 60 ml/min/1.73 m2 (Grade 3 or less) ; 60- 90 ml/min/1.73 m2 (Grade 2) ; < 90 ml/min/1.73m2 (grade 1 or normal). eGFR calculated at the end of 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 (21%) of 100 enrolled patients had normal eGFRs (Grade 0 or 1) above 90ml/min/1.73m2. Grade 2 renal dysfunction (eGFR between 60 and 90 ml/min/1.73m2) was present in 37 patients (37%), and 42 patients (42%) had Grade 3 dysfunction 0r less (eGFR < 60 ml/min 1.73m2). Microalbuminuria was detected in 47% of patients. Mean eGFR was 69.28. 70% of patients fall under Tenofovir based regimen. Of which 64 % patients falls in eGFR < 90 ml/min and in particular 38% falls under eGFR < 60 ml/min which indicates moderate to severe renal dysfunction. Majority of them in WHO clinical stage I and low CD4 count < 200 associated with decline in eGFR. CONCLUSION: Renal dysfunction was highly prevalent in this population of HIV-positive outpatients initiating first ART in Coimbatore Medical College Hospital, Coimbatore. 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.

Item Type: Thesis (Masters)
Uncontrolled Keywords: estimated glomerular filtration rate (eGFR) ; Antiretroviral Therapy (ART) ; Renal dysfunction.
Subjects: MEDICAL > General Medicine
Depositing User: Punitha K
Date Deposited: 18 May 2018 18:56
Last Modified: 22 May 2018 16:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/7933

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