Prevalence of microalbuminuria and associated factors among HIV - infected ART naive patients at Mulago hospital: a cross-sectional study in Uganda

BackgroundHIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naive patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naive patients in Uganda is unclear.MethodsA cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV-infected ART naive outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299mg/g and macroalbuminuria by a UACR >300mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher's exact test, quantile regression and logistic regression were used.ResultsA total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR=28-40) years and 428 (IQR=145-689) cells/mu L respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14-25%). None of the participants had macroalbuminuria. CD4+ count <350cells/<mu>L was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12-0.59), P value=0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria.ConclusionMicroalbuminuria was highly prevalent in adult HIV-infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV-infected patients.