Moderate to Severe Renal Insufficiency among Individuals with Human Immunodeficiency Virus Infection in Tanzania

Authors

  • Paschal J. Ruggajo Muhimbili University of Health and Allied Sciences
  • Ismail K. Abbas University of Dodoma
  • Joan J. Rugemalila Muhimbili National Hospital
  • David M. Sando Management and Development for Health
  • Ibraheem I. Abioye Harvard T.H. Chan School of Public Health
  • Ellen Hertzmark Harvard T.H. Chan School of Public Health
  • Donna Spiegelman Harvard T.H. Chan School of Public Health
  • Ferdinand M. Mugusi Muhimbili University of Health and Allied Sciences
  • Wafaie W. Fawzi Harvard T.H. Chan School of Public Health

DOI:

https://doi.org/10.4314/b6q3a531

Keywords:

Kidney disease, Risk factors, AIDS, HIV adult patients, Tanzania

Abstract

Background

Information about renal insufficiency and associated risk factors among people living with HIV (PLHIV) infection in East Africa is limited. The aim of this study was to determine the prevalence and factors associated with moderate to severe renal insufficiency among PLHIV in Dar es Salaam, Tanzania.

 Methods

A cross-sectional analysis of the baseline clinical data for 30,822 PLHIV who enrolled at the Management and Development for Health - Care and Treatment Clinics (MDH-CTCs) in Dar es Salam, Tanzania was done. Moderate to severe renal insufficiency was defined as estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2 based on the CKD-EPI equation.  Poisson regression models weighted by the inverse probability of inclusion in the study were used to estimate prevalence ratios for predictors of renal insufficiency.

Results

Our study population was relatively young [median age (IQR) of 35 (17-50) years], predominantly female (57% non-pregnant, 13.1% pregnant of all participants), and the majority (90.6%) were ART (Anti-Retroviral Therapy) naïve. The overall prevalence of moderate to severe renal insufficiency was 8.2%. In multivariable adjusted analysis, moderate to severe renal insufficiency was significantly associated with older age (i.e. ≥ 50 years) [Prevalence Ratio (PR) 2.16, 95% CI (1.70-2.75)], mid-upper-arm circumference under 22 cm [PR 1.48 (1.06, 2.07)], CD4+ cell counts of < 50 cells/mm3  [PR 1.43(1.10-1.85)]; and WHO HIV/AIDS stage IV [PR 16 2.09(1.40-3.11)].

Conclusion

Moderate to severe renal insufficiency is prevalent among PLHIV enrolled at Care and Treatment Centers in Dar es Salaam, Tanzania. In particular, older patients with advanced HIV/AIDS stage and poor liver function are more likely to present with moderate to severe renal insufficiency. However, further studies to explore the causal relationship between these associated risk factors and the outcomes (renal insufficiency) are warranted.

Author Biographies

  • Paschal J. Ruggajo, Muhimbili University of Health and Allied Sciences

    Associate Professor of Medicine and Consultant Nephrologist,

    Renal Research Group, Department of Internal Medicine, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania | Nephrology Unit, Medical College, Aga Khan University, Dar es Salaam, Tanzania

  • Ismail K. Abbas, University of Dodoma

    Department of Statistics, University of Dodoma, Dodoma, Tanzania

  • Joan J. Rugemalila, Muhimbili National Hospital

    Muhimbili National Hospital, Dar es Salaam, Tanzania

  • David M. Sando, Management and Development for Health

    Management and Development for Health, Dar es Salaam, Tanzania

  • Ibraheem I. Abioye, Harvard T.H. Chan School of Public Health

    Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

  • Ellen Hertzmark, Harvard T.H. Chan School of Public Health

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

  • Donna Spiegelman, Harvard T.H. Chan School of Public Health

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

  • Ferdinand M. Mugusi, Muhimbili University of Health and Allied Sciences

    Renal Research Group, Department of Internal Medicine, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

  • Wafaie W. Fawzi, Harvard T.H. Chan School of Public Health

    Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

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Published

2025-05-27

Issue

Vol. 36 No. 1 (2025)

Section

Original Research

How to Cite

Moderate to Severe Renal Insufficiency among Individuals with Human Immunodeficiency Virus Infection in Tanzania. (2025). Tanzania Medical Journal, 36(1), 16-30. https://doi.org/10.4314/b6q3a531

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