Kidney dysfunction in people living with HIV

Both the HIV virus and the antiretroviral drugs taken to treat it can cause kidney damage, but there are other risk factors at play. A twelve-year-long study in South Africa examined the relationship between kidney disease and mortality amongst people living with HIV. The results of the study were published in the journal aidsmap. 

Kidney function can be assessed by blood and urine testing. Blood is usually checked for waste products, which the kidneys should filter and remove from the blood, and urine is checked for protein levels. Protein in the urine can indicate that the kidney filtration system is not functioning properly.

3,039 people took part in the study. The average age of participants was 36 years old, and 62% of participants were women.

At the start of the study, 17% of participants showed signs of decreased kidney function. CD4 cell counts of below 200 were recorded in 45% of participants, and 2% were also living with diabetes.

Diabetes is one of the most common causes of kidney dysfunction - high blood sugar levels damage the kidneys’ filtration mechanism.

Another leading cause of renal failure is high blood pressure, but this study did not not factor in blood pressure to their findings.

Results

Around 10% of participants died during the course of this study. Most of them had very poor health at the time of enrolment.

Analysing the data for mortality and renal failure, the team found that participants who were found to have protein in their urine or mild renal impairment had an almost twice as likely probability of death. There wasn’t a link between risk of death and several renal impairment however, which the team attributed to the calculation method used, which over-estimates true renal function.

The researchers have also identified other individual factors that can exacerbate kidney problems and increase risk of death:

• Renal tuberculosis
• Hypertension
• Treatment for cryptococcal meningitis
• Other opportunistic infections

Taking into account the results of the study, experts are emphasising the need to regularly monitor the renal function of people living with HIV. Particular attention should be paid to those living with diabetes and hypertension. The study’s authors also suggest that HIV clinicians may wish to use more “kidney-friendly” treatment regimens.