Renal Tubular Dysfunction Among People Living with HIV on Tenofovir Disoproxil Fumarate in Uganda: A Hospital-Based Cross-Sectional Study

Abstract

Background Tenofovir Disoproxil Fumarate (TDF), the most commonly prescribed antiretroviral drug globally is associated with renal tubular dysfunction (RTD) whose magnitude is poorly understood in resource limited settings. Our goal was to describe the prevalence and factors associated with renal tubular dysfunction in Uganda's people living with HIV(PLHIV) taking TDF-containing regimens. Methods: We enrolled adult PLHIV receiving TDF-containing antiretroviral regimens from the HIV clinic at Mbarara Regional Referral Hospital. Socio-demographic, clinical and laboratory data were collected from each participant. Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) formula was used to estimate glomerular filtration rate (eGFR) and participants who had any two of, raised urinary excretion of phosphate, uric acid and glycosuria in non-diabetic normal glycemic were said to have renal tubular dysfunction. Logistic regression analysis was done to identify the factors that were independently associated with renal tubular dysfunction. Results: Of the 145 participants enrolled, 84 (57.9%) were female, and the mean age was 46 (± 9) years. The mean serum creatinine was 0.77 (± 0.12) mg/dl and the mean eGFR of 112 (±24) mL/min/1.73m2. A total of 116/145 (80%) participants had at least one abnormality in parameters of tubular dysfunction; 26 (17.9%) and 3 (2.1%) of the participants had a combination of two or more parameters, respectively. In our study, the prevalence of renal tubular dysfunction was 20% (29/145) (95% CI 14.2-27.3). Female gender was statistically significantly associated with tubular dysfunction, adjusted odds ratio (AOR): 2.75, 95% (CI. 1.05-7.19), p=0.03. Conclusion: The prevalence of renal tubular dysfunction is high and can occur in patients receiving TDF despite normal serum creatinine. We recommend using urinary abnormalities other than isolated serum creatinine in the detection of renal tubular dysfunction