Prevalence of Kidney Impairment and Mortality Among People Living With Hiv Admitted in a Sub-urban Hospital in Cameroon: A Retrospective Study

Prevalence of Kidney Impairment and Mortality Among People Living With Hiv Admitted in a Sub-urban Hospital in Cameroon: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence of Kidney Impairment and Mortality Among People Living With Hiv Admitted in a Sub-urban Hospital in Cameroon: A Retrospective Study Denis Georges Teuwafeu, Erson Ngankang Fodop, Clovis Nkoke, Mafouk Fopa Dianna Fontania, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7466658/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background The risk of kidney disease remains high in HIV-positive people, and kidney disease in people living with HIV (PLHIV) is associated with poor outcomes, including an increase in mortality. This study aimed to determine the prevalence of kidney impairment and its associated mortality risk in PLHIV admitted at Buea Regional Hospital (BRH), Cameroon. Methods A 5-year retrospective study was carried out at the BRH. Files of admitted HIV patients aged 18 or older from 01st January 2017 to 31st December 2021 were included. Demographic and clinical data were extracted. Renal function impairment was defined as eGFR < 60 ml/min/1.73 m² using MDRD (modification of diet in renal disease) equation. All serum creatinine levels were performed using the colorimetric method. Data were analysed using SPSS (statistical package for the social sciences) version 25. Bivariate and multivariate logistic regressions were performed to identify the association between the presence of kidney impairment and mortality. Statistical significance was set at a p-value < 0.05, with a confidence interval of 95%. Results We included a total of 890 patients, of whom 201 patients had kidney impairment, a prevalence of 26.1% with a male to female ratio of 1.008. The mean age of participants with kidney impairment was higher than those without, 46.8 ± 10.8 years and 42.9.1 ± 12.1 years, respectively (P = 0.001). The mortality rate among patients with kidney disease was statistically significantly higher (34.8%) compared to those without (23.5%). Participants with kidney impairment had statistically significantly higher odds of death during hospitalisation compared to those without kidney impairment (AOR = 1.55, 95% CI 1.04–2.32). Conclusion The prevalence of kidney impairment among admitted HIV-positive patients was considerably high, and the risk of death was higher in patients with kidney impairment compared to those without. These findings should prompt earlier screening, closer monitoring and follow-up of kidney disease among PLHIV. Health sciences/Diseases Health sciences/Medical research Health sciences/Nephrology Health sciences/Risk factors Kidney impairment PLHIV mortality risk sub-urban hospital Figures Figure 1 1. BACKGROUND Human immunodeficiency virus (HIV) infection remains the leading challenge worldwide( 1 , 2 ). At the end of 2023, an estimated 39.9 million people were living with HIV worldwide, 65% of whom we found in the World Health Organisation (WHO) African Region( 3 ). In 2023, an estimated 630,000 people died from HIV-related causes, and an estimated 1.3 million people were newly infected with HIV ( 3 ). In the era of antiretroviral therapy (ART), the overall life expectancy of HIV-positive people has increased substantially compared to the period before ART became readily available( 4 – 7 ). The morbidity and mortality associated with HIV infection have been mainly due to opportunistic infections (OIs) ( 4 , 8 ). In developed countries, OIs have been replaced by chronic or non-communicable diseases, whereas in developing countries like Cameroon, both the OIs and non-communicable diseases account for a high HIV-related morbidity and mortality( 4 , 9 – 12 ). Kidney disease, defined as kidney damage or reduced kidney function( 13 , 14 ), has emerged as one of the predominant non-communicable co-morbidities seen among PLHIV( 15 – 17 ). In this regard, HIV-positive patients are at higher risk for kidney diseases, including acute kidney injury (AKI) and chronic kidney disease (CKD) (reduced function for more than 3 months), which are interrelated syndromes responsible for an increasing burden of morbidity and mortality( 15 , 18 – 20 ). Renal pathology in HIV-positive people is diverse, including lesions directly related to intrarenal HIV gene expression and lesions related to co-morbidities (including diabetes mellitus, metabolic syndrome, hypertension, atherosclerosis, etc.), drug effects (including antiretroviral therapy, antibiotics, etc.), immune dysregulation (including lupus, rheumatoid arthritis, etc.) and co-infections( 18 , 21 , 22 ). Although HIV-associated nephropathy (HIVAN) and HIV-immune complex kidney disease (HIVICK) are the best-known examples of HIV-associated kidney diseases, a large spectrum of kidney syndromes are also known to occur in HIV-positive patients( 18 , 23 , 24 ). Black people are more prone to HIV-associated kidney disease due to predisposing genetic factors( 25 – 27 ). There is substantial literature available on HIV/AIDS in sub-Saharan Africa (SSA), but there is limited information about the mortality with kidney disease in admitted HIV-positive patients in Cameroon, especially in the South-West region. We therefore aimed to determine the prevalence of kidney disease and its associated mortality risk in PLHIV admitted at Buea Regional Hospital (BRH), Cameroon. 2. MATERIALS AND METHODS 2.1 Study design, setting, population and sampling This was a 5-year hospital-based retrospective study. The Buea Regional Hospital (BRH) is a secondary healthcare facility which serves as a referral centre for the region. The hospital has an HIV treatment centre that operates a day-care centre. PLHIV (people living with HIV) are admitted to the internal medicine ward from the outpatient department and the HIV treatment centre. All files of PLHIV aged 18 and above admitted at the BRH from 1st January 2017 to 31st December 2021 were reviewed. We used a convenient sampling method, intending to review all files of HIV patients admitted during the study period. 2.2 Study procedure Data collection : The files were sorted from the archives of the various admission wards. The data were retrieved using a well-designed data collection form. Information retrieved included demographic data (age and gender), clinical data including the patient’s diagnosis (or diagnoses) during admission, patient’s past medical history, clinical stage, cotrimoxazole (CMX) prophylaxis, and outcome (discharge or death). The cause of admission was defined as the diagnosis that led to the patient’s hospitalisation. Kidney function impairment was defined as patients with eGFR < 60 ml/min/1.73m 2 (using MDRD equation for eGFR calculation) upon admission regardless of the duration, their previous eGFR, their histopathologic aetiology or their ART status. Poor outcome was defined as patients who died during hospitalisation. The term mortality risk was used to estimate the likelihood of in-hospital death for a patient. Data management and analysis : Data were entered in a Microsoft Excel database and analysed using Statistical Packages for Social Sciences (SPSS) version 25 for Windows. A multivariate logistic regression with relevant covariates in the bivariate analyses was used to assess mortality risk. Statistical significance was set at a p-value < 0.05, with a confidence interval of 95%. Continuous variables were presented as means, standard deviations, medians with interquartile range, while categorical variables were presented as frequency and proportion to ease organisation and comprehension of results. Ethical considerations : Ethical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Health Sciences, the University of Buea (2022/1601-01/UB/SG/IRB/FHS). Authorisation to carry out the research was obtained from the Dean of the Faculty of Health Sciences of the University of Buea. Administrative approvals were sought from the Southwest delegation of public health and the director of the BRH. To ensure patient confidentiality, the information obtained from the files was coded so their identity would not be revealed. 3. RESULTS Out of the 10328 files screened, 982 files met the inclusion criterion; the proportion of admission of HIV/AIDS patients in BRH during the study period was 9.5%. Ninety-two files were excluded, giving a final sample size of 890. See Fig. 1 . Among the total of patients included (890), 42% (376) were men and 57.8% (514) were women. The mean age of participants was 43.7 ± 11.9 years. A total of 201 patients out of 890 had kidney impairment, giving a prevalence of 22.6%. The mean age of participants with kidney injury was statistically significantly different from that of those without kidney injury, 46.8 ± 10.8 and 42.9 ± 12.1, respectively (P = 0.001). Among participants with kidney disease, 101(50.2%) were males, while 100(49.8%) were females. See Table 1 . Having an associated diagnosis (more than one working diagnosis), use of CMX prophylaxis and WHO HIV clinical stage 4, were statistically significantly associated with renal function impairment. See Table 2 . Table 1 Demographic characteristics of participants Variables Total Renal function impairment P-value Yes (%) No (%) Total 890 (100%) 201(22.6%) 689(77.4%) Age (years), Mean ± SD 43.7 ± 11.9 46.8 ± 10.8 42.9 ± 12.1 < 0.001 Gender N (%) Male 376(42.2) 101(50.2%) 275(39.9%) 0.011 Female 514(57.8) 100(49.8%) 414(60.1%) SD: standard deviation, N: number; chi-square test p-value < 0.05 Table 2 Clinical characteristics of the participants Variable category Renal Function Impairment Total N (%) P-value Yes n (%) No n (%) Associated diagnosis no 70(34.8) 454(65.9) 524(58.9) < 0.001 yes 131(65.2) 235(34.1) 366(41.1) CMX prophylaxis No 79(39.3) 378(54.9) 457(51.3) < 0.001 Yes 122(64.4) 311(45.1) 433(48.7) WHO HIV clinical stage Stage 1 7(3.5) 49(7.1) 56(6.3) < 0.001 Stage 2 20( 10 ) 89(12.9) 109(12.2) Stage 3 40(19.9) 327(47.5) 367(41.2) Stage 4 134(66.7) 224(32.5) 358(40.2) CMX: cotrimoxazole, WHO: world health organization, HIV: human immunodeficiency virus, n: number, chi-square test p-value < 0.05 The majority of admitted PLHIV was discharged home and the overall mortality rate in the studied population was 26.1%. The mortality rate among patients with kidney disease was significantly higher (34.8%) compared to those without kidney impairment (23.5%). A bivariate analysis revealed that patients with kidney impairment were more likely to die during admission than those without (OR = 1.78, 95% CI 1.26–2.51). A multivariate logistic regression confirmed that kidney impairment remains an independent predictor of in-hospital mortality (AOR = 1.55, 95% CI 1.04–2.32), after controlling for Age, sex presence of another diagnosis, comorbidities (such as Diabetes, hypertension, hepatitis b or c, etc.), WHO HIV clinical stage, ART status and CMX status. Another factor significantly associated with a higher risk of in-hospital mortality includes an advanced WHO HIV clinical status (AOR = 1.37, 95% CI 1.12–1.68), whereas being on prophylaxis use (CMX) was strongly protective (AOR = 0.42, 95% CI 0.29–0.58). See Table 3 to 5 . Table 3 Outcome of hospitalisation Outcome Frequency Proportion (%) Death 232 26.1 Discharged 640 71.9 Referred 18 2.0 Table 4 mortality rates and association of kidney impairment and mortality variables Total Renal Function Impairment OR 95%CI P value Yes No Death Yes 232(26.1%) 70(34.8%) 162(23.5%) 1.78 1.26–2.51 0.001 No 658 (83.9%) 131(65.2%) 527(76.4%) OR: adjusted odds ratio, CI: confidence interval; bivariate logistic regression p-value < 0.05 Table 5 Factors associated with mortality on multivariate logistic regression Variables Category AOR 95%CI P-value Renal failure Yes 1.55 1.04–2.32 0.032 No CMX prophylaxis Yes 0.42 0.29–0.58 < 0.001 No WHO clinical stage Stage 1 Stage 2 Stage 3 Stage 4 1.37 1.12–1.68 0.002 AOR: adjusted odds ratio, CI: confidence interval; multivariate analysis p-value < 0.05 4. DISCUSSION The findings of this study revealed a considerably high prevalence of kidney disease among admitted PLHIV at 22.6%. This finding on the prevalence of kidney dysfunction is comparable with some studies conducted in sub-Saharan Africa, in which the overall prevalence ranged from 16.1–23.3%( 4 , 28 – 30 ). However, the result of this study is much higher than the ones conducted in Canada (0.7%)( 31 ), Zimbabwe (7.3%) ( 32 ), China (12.5%)( 33 ), and in Japan (13.5%). The fact that the Chinese study focused on incidence, the Zimbabwean study focused on patients commencing ART, the Japanese study focused on incidence of CKD and the Canadian study focused on the effect of Tenofovir Disoproxil Fumarate (TDF) on the development of AKI could explain the significant discrepancies. A Nigerian study revealed a very high prevalence (41.1%) of kidney impairment among adult PLHIV on ART( 34 ). We believe that variations in population demographics and genetic predisposition are potential factors which could explain the observed disparity. Additionally, black people living with HIV worldwide have shown to have an increased risk of developing kidney impairment( 21 , 35 ). As seen in the Nigerian study mentioned above, we also found that there is a likelihood of kidney function impairment after adjusting for WHO clinical stage. Furthermore, a systematic review and meta-analysis concluded that PLHIV have a further increased risk of renal disease at later stages of infection and at older ages( 36 ); our study demonstrated that Patients with renal impairment were on average 4 years older than those without (≈ 47 versus 43 years respectively). HIVAN is a frequent component of kidney function impairment especially in black PLHIV and it is recognized as a complication of advanced HIV disease, with a pathogenesis that involves direct HIV infection of tubular and glomerular epithelial cells( 37 ). Also, it has been shown that increasing age leads to greater predisposition to lower eGFR, to greater regression of renal function( 38 ). Mortality rate among PLHIV with kidney disease in this study was as high as 34.8%, versus 23.5% among PLHIV without kidney disease. These results are comparable with a study conducted in Portugal and in Puerto Rico, revealing 31.3% and 15.9% for HIV-positive patients with kidney impairment versus 16.5% and 5.7% for those without kidney impairment respectively( 39 , 40 ).The high mortality observed in this study could be due to the advanced WHO HIV stage at presentation, especially among patients with kidney disease; another reason could be the lack of resources for care. This study also confirmed that kidney impairment was an independent predictor of in-hospital mortality with a 1.55-fold increased risk after controlling for other cofactors. This result is in line with similar prior studies conducted where the presence of kidney dysfunction was significantly associated with increased mortality in HIV-positive patients, with odds ratios ranging from 1.4 to 2.3( 17 , 32 , 39 , 41 , 42 ). Other potential important factors that could have significantly contributed to this association include proteinuria, CD4 + T cell counts and being underweight, but these were not taken into consideration in this study and may contribute to a limitation( 32 , 40 ). Importantly, the risk of death in participants with kidney impairment in our study was considerably lower compared to a prior study conducted about two decades ago, with odds ratios being 5.3( 43 ). This could be explained by the fact that medicine, quality and means of care have globally and considerably improved over the years. Another factor that was found to be an independent predictor of in-hospital mortality in this study includes having an advanced WHO HIV clinical status on admission, whereas being on prophylaxis use (CMX) was strongly protective. LIMITATIONS This was a retrospective review of patient records and thus prone to missing data such as laboratory data (blood cells counts, CD4 counts, viral load, urinalysis, etc.), reason why this was not considered in our study. We also had some selection biases; given that our study was done in a single hospital, patients admitted to the hospital may not be representative of all admitted PLHIV in the community, and may not also be a true reflection of in-hospital mortality in the general population of Cameroon. Another potential limitation is the possible impact of ethnicity and body wasting (usually found in WHO HIV clinical stage IV patients) on MDRD equation for an eGFR accurate calculation. All of these may lower the strength and generalisability of our conclusion. CONCLUSION This study demonstrates that kidney impairment is a common and clinically significant issue among admitted PLHIV. Patients with any recorded renal dysfunction arrived sicker, with more advanced HIV, greater comorbidity burden, and substantially higher in-hospital mortality compared to those without renal involvement. Even after accounting for these differences, renal failure emerged as an independent predictor of poorer prognosis. Targeted strategies to proactively identify and manage renal complications may be warranted to improve outcomes in this high-risk population. Abbreviations AIDS: Acquired immunodeficiency syndrome AKI: Acute kidney injury ART: Antiretroviral treatment BRH: Buea Regional Hospital CKD: Chronic kidney disease CMX: Cotrimoxazole FHS: Faculty of Health Sciences HAART: Highly active antiretroviral therapy HIV: Human immunodeficiency virus HIVAN: HIV-associated nephropathy HIVICK: HIV-immune complex kidney disease IRB: Institutional Review Board OIs: Opportunistic infections PLHIV: People living with HIV SPSS: Statistical package for social sciences SSA: sub-Saharan Africa WHO: World Health Organisation Declarations Ethics approval and consent to participate Ethical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Health Sciences, the University of Buea (2022/1601-01/UB/SG/IRB/FHS). Authorisation to carry out the research was obtained from the Dean of the Faculty of Health Sciences of the University of Buea. Administrative approvals were sought from the Southwest delegation of public health and the director of the BRH. To ensure patient confidentiality, the information obtained from the files was coded so their identity would not be revealed. This Research was carried out in compliance with the Helsinki Declaration and each adult participant was required to sign an informed consent form, and for children less than 18, an ascent was obtained from the parent or the guardian. Consent for publication: Not applicable Clinical trial number: Not applicable. Availability of data and materials The datasets supporting the findings are not publicly available to protect confidentiality. However, they will be freely available to any scientist wishing to use them for non-commercial purposes from the corresponding author ( [email protected] ) upon reasonable request and subject to approval by the IRB of the Faculty of Health Sciences, University of Buea. Competing interests The authors declare that they have no competing interests. Funding The authors did not receive any funding for the study or the publication Authors' contributions D.G.T., E.N.F., C.K., M.M., N.C.N., and D.F.M.F. were responsible entirely for the conception and design of the study. D.G.T., E.N.F., C.K., M.M., N.C.N., S.P.C. Designed data collection tools, collected and monitored data collection for the whole trial, cleaned, analysed and interpreted the data, and drafted the manuscript. D.G.T, E.N.F, C.K, M.M, N.C.N, D.F.M.F and S.P.C. revised the paper and produced the final manuscript. All the authors have read and approved the final manuscript. Acknowledgements Not applicable References Tian X, Chen J, Wang X, Xie Y, Zhang X, Han D, et al. Global, regional, and national HIV/AIDS disease burden levels and trends in 1990–2019: A systematic analysis for the global burden of disease 2019 study. Front Public Health. 2023 Feb 15;11:1068664. Demberg T, Robert-Guroff M. 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Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS Lond Engl. 2006 Feb 28;20(4):561–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviews received at journal 25 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 05 Jan, 2026 Editor assigned by journal 30 Dec, 2025 Editor invited by journal 02 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7466658","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":518760151,"identity":"caeda4d0-7c34-4849-a976-5bdd1bd04bbc","order_by":0,"name":"Denis Georges Teuwafeu","email":"","orcid":"","institution":"Buea Regional Hospital","correspondingAuthor":false,"prefix":"","firstName":"Denis","middleName":"Georges","lastName":"Teuwafeu","suffix":""},{"id":518760152,"identity":"153a9c74-81b0-448d-b5e0-e64d592f9ae9","order_by":1,"name":"Erson Ngankang Fodop","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBAC9gYGAyiT+QCQkJAhqIXnAFwLWwJICw8pWnjADCK0sDdvfFxQcc+eX7rn86sbNRY8DOyHj27Aq4XnWLHxjDPFiTPnnN1mnXMM6DCetLQb+LTYS+SYSfO2JSQY3MjdZpzDBtQiwWOGVwsPWMu/BHuDGznPjHP+Ea2lIYFxw40c5se5bcRoAfvlWELizBlpZsy5fRI8bIT8AgmxmgR7fonkx59zvtXJ8bMfPoZXCwgwQ2k2CTBJSDmyFuYPxKgeBaNgFIyCkQcAqN1CDV3r09cAAAAASUVORK5CYII=","orcid":"","institution":"University of Buea","correspondingAuthor":true,"prefix":"","firstName":"Erson","middleName":"Ngankang","lastName":"Fodop","suffix":""},{"id":518760153,"identity":"dc2e8d3f-7132-4606-80d6-292eae23d7a8","order_by":2,"name":"Clovis Nkoke","email":"","orcid":"","institution":"Buea Regional Hospital","correspondingAuthor":false,"prefix":"","firstName":"Clovis","middleName":"","lastName":"Nkoke","suffix":""},{"id":518760154,"identity":"2198f288-a7a9-4157-9ef8-b0da1ffc6bf9","order_by":3,"name":"Mafouk Fopa Dianna 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Simeon","middleName":"Pierre","lastName":"Choukem","suffix":""}],"badges":[],"createdAt":"2025-08-27 00:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7466658/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7466658/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92069212,"identity":"1730ecc1-9c68-451a-962b-bb729b5450ae","added_by":"auto","created_at":"2025-09-24 09:30:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":167036,"visible":true,"origin":"","legend":"","description":"","filename":"RESEARCHARTICLE2.editedbonSPC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7466658/v1/f7e85cbb75c18e15e4e4c714.docx"},{"id":92069379,"identity":"26b15a72-b9bb-4126-a4a2-6bbef387a483","added_by":"auto","created_at":"2025-09-24 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09:30:50","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95745,"visible":true,"origin":"","legend":"","description":"","filename":"2ee367e6c3fa41b39684d915ba697d8a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7466658/v1/1ee9a8453c89c47f14d3b613.xml"},{"id":92069383,"identity":"e914da68-97f2-487f-9c7a-8aab4c7e7bf2","added_by":"auto","created_at":"2025-09-24 09:30:52","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108138,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7466658/v1/69df9c3511f8d7b1801823e4.html"},{"id":92069403,"identity":"72d39d87-cfe0-450d-8cc5-e886ee91b138","added_by":"auto","created_at":"2025-09-24 09:30:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55170,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRecruitment flow chart.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7466658/v1/92317e84cda25d7c8e4d0e5c.png"},{"id":92070851,"identity":"3a7142d7-c816-4743-ab4a-ea1376db3b4d","added_by":"auto","created_at":"2025-09-24 09:39:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":792935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7466658/v1/bc0254d0-fe42-49d7-8a14-d39e7bd48f29.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence of Kidney Impairment and Mortality Among People Living With Hiv Admitted in a Sub-urban Hospital in Cameroon: A Retrospective Study\u003c/p\u003e","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003eHuman immunodeficiency virus (HIV) infection remains the leading challenge worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). At the end of 2023, an estimated 39.9\u0026nbsp;million people were living with HIV worldwide, 65% of whom we found in the World Health Organisation (WHO) African Region(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In 2023, an estimated 630,000 people died from HIV-related causes, and an estimated 1.3\u0026nbsp;million people were newly infected with HIV (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In the era of antiretroviral therapy (ART), the overall life expectancy of HIV-positive people has increased substantially compared to the period before ART became readily available(\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The morbidity and mortality associated with HIV infection have been mainly due to opportunistic infections (OIs) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In developed countries, OIs have been replaced by chronic or non-communicable diseases, whereas in developing countries like Cameroon, both the OIs and non-communicable diseases account for a high HIV-related morbidity and mortality(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKidney disease, defined as kidney damage or reduced kidney function(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), has emerged as one of the predominant non-communicable co-morbidities seen among PLHIV(\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this regard, HIV-positive patients are at higher risk for kidney diseases, including acute kidney injury (AKI) and chronic kidney disease (CKD) (reduced function for more than 3 months), which are interrelated syndromes responsible for an increasing burden of morbidity and mortality(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Renal pathology in HIV-positive people is diverse, including lesions directly related to intrarenal HIV gene expression and lesions related to co-morbidities (including diabetes mellitus, metabolic syndrome, hypertension, atherosclerosis, etc.), drug effects (including antiretroviral therapy, antibiotics, etc.), immune dysregulation (including lupus, rheumatoid arthritis, etc.) and co-infections(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Although HIV-associated nephropathy (HIVAN) and HIV-immune complex kidney disease (HIVICK) are the best-known examples of HIV-associated kidney diseases, a large spectrum of kidney syndromes are also known to occur in HIV-positive patients(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Black people are more prone to HIV-associated kidney disease due to predisposing genetic factors(\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is substantial literature available on HIV/AIDS in sub-Saharan Africa (SSA), but there is limited information about the mortality with kidney disease in admitted HIV-positive patients in Cameroon, especially in the South-West region. We therefore aimed to determine the prevalence of kidney disease and its associated mortality risk in PLHIV admitted at Buea Regional Hospital (BRH), Cameroon.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design, setting, population and sampling\u003c/h2\u003e\u003cp\u003eThis was a 5-year hospital-based retrospective study. The Buea Regional Hospital (BRH) is a secondary healthcare facility which serves as a referral centre for the region. The hospital has an HIV treatment centre that operates a day-care centre. PLHIV (people living with HIV) are admitted to the internal medicine ward from the outpatient department and the HIV treatment centre.\u003c/p\u003e\u003cp\u003eAll files of PLHIV aged 18 and above admitted at the BRH from 1st January 2017 to 31st December 2021 were reviewed. We used a convenient sampling method, intending to review all files of HIV patients admitted during the study period.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study procedure\u003c/h2\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe files were sorted from the archives of the various admission wards. The data were retrieved using a well-designed data collection form. Information retrieved included demographic data (age and gender), clinical data including the patient\u0026rsquo;s diagnosis (or diagnoses) during admission, patient\u0026rsquo;s past medical history, clinical stage, cotrimoxazole (CMX) prophylaxis, and outcome (discharge or death). The cause of admission was defined as the diagnosis that led to the patient\u0026rsquo;s hospitalisation. Kidney function impairment was defined as patients with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e (using MDRD equation for eGFR calculation) upon admission regardless of the duration, their previous eGFR, their histopathologic aetiology or their ART status. Poor outcome was defined as patients who died during hospitalisation. The term mortality risk was used to estimate the likelihood of in-hospital death for a patient.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData management and analysis\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eData were entered in a Microsoft Excel database and analysed using Statistical Packages for Social Sciences (SPSS) version 25 for Windows. A multivariate logistic regression with relevant covariates in the bivariate analyses was used to assess mortality risk. Statistical significance was set at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with a confidence interval of 95%. Continuous variables were presented as means, standard deviations, medians with interquartile range, while categorical variables were presented as frequency and proportion to ease organisation and comprehension of results.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Health Sciences, the University of Buea (2022/1601-01/UB/SG/IRB/FHS). Authorisation to carry out the research was obtained from the Dean of the Faculty of Health Sciences of the University of Buea. Administrative approvals were sought from the Southwest delegation of public health and the director of the BRH. To ensure patient confidentiality, the information obtained from the files was coded so their identity would not be revealed.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eOut of the 10328 files screened, 982 files met the inclusion criterion; the proportion of admission of HIV/AIDS patients in BRH during the study period was 9.5%. Ninety-two files were excluded, giving a final sample size of 890. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong the total of patients included (890), 42% (376) were men and 57.8% (514) were women. The mean age of participants was 43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9 years. A total of 201 patients out of 890 had kidney impairment, giving a prevalence of 22.6%. The mean age of participants with kidney injury was statistically significantly different from that of those without kidney injury, 46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 and 42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1, respectively (P\u0026thinsp;=\u0026thinsp;0.001). Among participants with kidney disease, 101(50.2%) were males, while 100(49.8%) were females. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eHaving an associated diagnosis (more than one working diagnosis), use of CMX prophylaxis and WHO HIV clinical stage 4, were statistically significantly associated with renal function impairment. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRenal function impairment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e890 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e201(22.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e689(77.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGender N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e376(42.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101(50.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e275(39.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e514(57.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100(49.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e414(60.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD: standard deviation, N: number; chi-square test p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ecategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eRenal Function Impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eYes n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNo n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAssociated diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e454(65.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e524(58.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131(65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e235(34.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e366(41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCMX prophylaxis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79(39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e378(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e457(51.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122(64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e311(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e433(48.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWHO HIV clinical stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49(7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89(12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e109(12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(19.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e327(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e367(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134(66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e224(32.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e358(40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eCMX: cotrimoxazole, WHO: world health organization, HIV: human immunodeficiency virus, n: number, chi-square test p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe majority of admitted PLHIV was discharged home and the overall mortality rate in the studied population was 26.1%. The mortality rate among patients with kidney disease was significantly higher (34.8%) compared to those without kidney impairment (23.5%). A bivariate analysis revealed that patients with kidney impairment were more likely to die during admission than those without (OR\u0026thinsp;=\u0026thinsp;1.78, 95% CI 1.26\u0026ndash;2.51). A multivariate logistic regression confirmed that kidney impairment remains an independent predictor of in-hospital mortality (AOR\u0026thinsp;=\u0026thinsp;1.55, 95% CI 1.04\u0026ndash;2.32), after controlling for Age, sex presence of another diagnosis, comorbidities (such as Diabetes, hypertension, hepatitis b or c, etc.), WHO HIV clinical stage, ART status and CMX status. Another factor significantly associated with a higher risk of in-hospital mortality includes an advanced WHO HIV clinical status (AOR\u0026thinsp;=\u0026thinsp;1.37, 95% CI 1.12\u0026ndash;1.68), whereas being on prophylaxis use (CMX) was strongly protective (AOR\u0026thinsp;=\u0026thinsp;0.42, 95% CI 0.29\u0026ndash;0.58). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e to \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOutcome of hospitalisation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e232\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReferred\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003emortality rates and association of kidney impairment and mortality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eRenal Function Impairment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e232(26.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(34.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e162(23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.26\u0026ndash;2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e658 (83.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131(65.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e527(76.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eOR: adjusted odds ratio, CI: confidence interval; bivariate logistic regression p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with mortality on multivariate logistic regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRenal failure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.04\u0026ndash;2.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCMX prophylaxis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.29\u0026ndash;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWHO clinical stage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 1\u003c/p\u003e\u003cp\u003eStage 2\u003c/p\u003e\u003cp\u003eStage 3\u003c/p\u003e\u003cp\u003eStage 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.12\u0026ndash;1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAOR: adjusted odds ratio, CI: confidence interval; multivariate analysis p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe findings of this study revealed a considerably high prevalence of kidney disease among admitted PLHIV at 22.6%. This finding on the prevalence of kidney dysfunction is comparable with some studies conducted in sub-Saharan Africa, in which the overall prevalence ranged from 16.1\u0026ndash;23.3%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, the result of this study is much higher than the ones conducted in Canada (0.7%)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), Zimbabwe (7.3%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), China (12.5%)(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), and in Japan (13.5%). The fact that the Chinese study focused on incidence, the Zimbabwean study focused on patients commencing ART, the Japanese study focused on incidence of CKD and the Canadian study focused on the effect of Tenofovir Disoproxil Fumarate (TDF) on the development of AKI could explain the significant discrepancies. A Nigerian study revealed a very high prevalence (41.1%) of kidney impairment among adult PLHIV on ART(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). We believe that variations in population demographics and genetic predisposition are potential factors which could explain the observed disparity. Additionally, black people living with HIV worldwide have shown to have an increased risk of developing kidney impairment(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs seen in the Nigerian study mentioned above, we also found that there is a likelihood of kidney function impairment after adjusting for WHO clinical stage. Furthermore, a systematic review and meta-analysis concluded that PLHIV have a further increased risk of renal disease at later stages of infection and at older ages(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e); our study demonstrated that Patients with renal impairment were on average 4 years older than those without (\u0026asymp;\u0026thinsp;47 versus 43 years respectively). HIVAN is a frequent component of kidney function impairment especially in black PLHIV and it is recognized as a complication of advanced HIV disease, with a pathogenesis that involves direct HIV infection of tubular and glomerular epithelial cells(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Also, it has been shown that increasing age leads to greater predisposition to lower eGFR, to greater regression of renal function(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMortality rate among PLHIV with kidney disease in this study was as high as 34.8%, versus 23.5% among PLHIV without kidney disease. These results are comparable with a study conducted in Portugal and in Puerto Rico, revealing 31.3% and 15.9% for HIV-positive patients with kidney impairment versus 16.5% and 5.7% for those without kidney impairment respectively(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).The high mortality observed in this study could be due to the advanced WHO HIV stage at presentation, especially among patients with kidney disease; another reason could be the lack of resources for care.\u003c/p\u003e\u003cp\u003eThis study also confirmed that kidney impairment was an independent predictor of in-hospital mortality with a 1.55-fold increased risk after controlling for other cofactors. This result is in line with similar prior studies conducted where the presence of kidney dysfunction was significantly associated with increased mortality in HIV-positive patients, with odds ratios ranging from 1.4 to 2.3(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Other potential important factors that could have significantly contributed to this association include proteinuria, CD4\u0026thinsp;+\u0026thinsp;T cell counts and being underweight, but these were not taken into consideration in this study and may contribute to a limitation(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Importantly, the risk of death in participants with kidney impairment in our study was considerably lower compared to a prior study conducted about two decades ago, with odds ratios being 5.3(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). This could be explained by the fact that medicine, quality and means of care have globally and considerably improved over the years. Another factor that was found to be an independent predictor of in-hospital mortality in this study includes having an advanced WHO HIV clinical status on admission, whereas being on prophylaxis use (CMX) was strongly protective.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLIMITATIONS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a retrospective review of patient records and thus prone to missing data such as laboratory data (blood cells counts, CD4 counts, viral load, urinalysis, etc.), reason why this was not considered in our study.\u003c/p\u003e\u003cp\u003eWe also had some selection biases; given that our study was done in a single hospital, patients admitted to the hospital may not be representative of all admitted PLHIV in the community, and may not also be a true reflection of in-hospital mortality in the general population of Cameroon.\u003c/p\u003e\u003cp\u003eAnother potential limitation is the possible impact of ethnicity and body wasting (usually found in WHO HIV clinical stage IV patients) on MDRD equation for an eGFR accurate calculation.\u003c/p\u003e\u003cp\u003eAll of these may lower the strength and generalisability of our conclusion.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that kidney impairment is a common and clinically significant issue among admitted PLHIV. Patients with any recorded renal dysfunction arrived sicker, with more advanced HIV, greater comorbidity burden, and substantially higher in-hospital mortality compared to those without renal involvement. Even after accounting for these differences, renal failure emerged as an independent predictor of poorer prognosis. Targeted strategies to proactively identify and manage renal complications may be warranted to improve outcomes in this high-risk population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS: Acquired immunodeficiency syndrome\u003c/p\u003e\n\u003cp\u003eAKI: Acute kidney injury\u003c/p\u003e\n\u003cp\u003eART: Antiretroviral treatment\u003c/p\u003e\n\u003cp\u003eBRH: Buea Regional Hospital\u003c/p\u003e\n\u003cp\u003eCKD: Chronic kidney disease\u003c/p\u003e\n\u003cp\u003eCMX: Cotrimoxazole\u003c/p\u003e\n\u003cp\u003eFHS: Faculty of Health Sciences\u003c/p\u003e\n\u003cp\u003eHAART: Highly active antiretroviral therapy\u003c/p\u003e\n\u003cp\u003eHIV: Human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003eHIVAN: HIV-associated nephropathy\u003c/p\u003e\n\u003cp\u003eHIVICK: HIV-immune complex kidney disease\u003c/p\u003e\n\u003cp\u003eIRB: Institutional Review Board\u003c/p\u003e\n\u003cp\u003eOIs: Opportunistic infections\u003c/p\u003e\n\u003cp\u003ePLHIV: People living with HIV\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical package for social sciences\u003c/p\u003e\n\u003cp\u003eSSA: sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organisation \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Health Sciences, the University of Buea (2022/1601-01/UB/SG/IRB/FHS). Authorisation to carry out the research was obtained from the Dean of the Faculty of Health Sciences of the University of Buea. Administrative approvals were sought from the Southwest delegation of public health and the director of the BRH. To ensure patient confidentiality, the information obtained from the files was coded so their identity would not be revealed. \u003c/p\u003e\n\u003cp\u003eThis Research was carried out in compliance with the Helsinki Declaration and each adult participant was required to sign an informed consent form, and for children less than 18, an ascent was obtained from the parent or the guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the findings are not publicly available to protect confidentiality. However, they will be freely available to any scientist wishing to use them for non-commercial purposes from the corresponding author ([email protected]) upon reasonable request and subject to approval by the IRB of the Faculty of Health Sciences, University of Buea. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for the study or the publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.G.T., E.N.F., C.K., M.M., N.C.N., and D.F.M.F. were responsible entirely for the conception and design of the study. D.G.T., E.N.F., C.K., M.M., N.C.N., S.P.C. Designed data collection tools, collected and monitored data collection for the whole trial, cleaned, analysed and interpreted the data, and drafted the manuscript. D.G.T, E.N.F, C.K, M.M, N.C.N, D.F.M.F and S.P.C. revised the paper and produced the final manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTian X, Chen J, Wang X, Xie Y, Zhang X, Han D, et al. Global, regional, and national HIV/AIDS disease burden levels and trends in 1990\u0026ndash;2019: A systematic analysis for the global burden of disease 2019 study. Front Public Health. 2023 Feb 15;11:1068664. \u003c/li\u003e\n\u003cli\u003eDemberg T, Robert-Guroff M. Controlling the HIV/AIDS epidemic: current status and global challenges. Front Immunol. 2012;3:250. \u003c/li\u003e\n\u003cli\u003eHIV and AIDS [Internet]. [cited 2025 Jan 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids\u003c/li\u003e\n\u003cli\u003eManaye GA, Abateneh DD, Niguse W. \u0026lt;p\u0026gt;Chronic Kidney Disease and Associated Factors Among HIV/AIDS Patients on HAART in Ethiopia\u0026lt;/p\u0026gt;. HIVAIDS - Res Palliat Care. 2020 Oct 19;12:591\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAlthoff KN, McGinnis KA, Wyatt CM, Freiberg MS, Gilbert C, Oursler KK, et al. Comparison of Risk and Age at Diagnosis of Myocardial Infarction, End-Stage Renal Disease, and Non-AIDS-Defining Cancer in HIV-Infected Versus Uninfected Adults. Clin Infect Dis. 2015 Feb 15;60(4):627\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eNakagawa F, Lodwick RK, Smith CJ, Smith R, Cambiano V, Lundgren JD, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS. 2012 Jan 28;26(3):335. \u003c/li\u003e\n\u003cli\u003eSamji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada. PLOS ONE. 2013 d\u0026eacute;c;8(12):e81355. \u003c/li\u003e\n\u003cli\u003eFord N, Shubber Z, Meintjes G, Grinsztejn B, Eholie S, Mills EJ, et al. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV. 2015 Oct 1;2(10):e438\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eWools-Kaloustian KK, Gupta SK. Will there be an epidemic of HIV-related chronic kidney disease in sub-Saharan Africa? Too soon to tell. Kidney Int. 2008 Oct 1;74(7):845\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eEchekwube PO, Iwuozo EU, Sagay H. Causes of Hospitalization and Predictors of Mortality among Adult HIV Positive Patients at the Benue State University Teaching Hospital, Makurdi. J Adv Med Med Res. 2020 Mar 20;88\u0026ndash;97. \u003c/li\u003e\n\u003cli\u003eMarcel T. Causes of admission and outcome of HIV patients in CHUK (Centre Universitaire de Kigali). J Infect Dis Prev Med [Internet]. 2022 Mar 3 [cited 2025 Jan 6]; Available from: https://www.longdom.org/\u003c/li\u003e\n\u003cli\u003eSaavedra A, Campinha-Bacote N, Hajjar M, Kenu E, Gillani FS, Obo-Akwa A, et al. Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital. Pan Afr Med J. 2017;27:48. \u003c/li\u003e\n\u003cli\u003eNational Institute of Diabetes and Digestive and Kidney Diseases [Internet]. [cited 2025 Jan 6]. Kidney Disease - NIDDK. Available from: https://www.niddk.nih.gov/health-information/kidney-disease\u003c/li\u003e\n\u003cli\u003eSzczech LA, Hoover DR, Feldman JG, Cohen MH, Gange SJ, Gooz\u0026eacute; L, et al. Association between Renal Disease and Outcomes among HIV-Infected Women Receiving or Not Receiving Antiretroviral Therapy. Clin Infect Dis. 2004 Oct 15;39(8):1199\u0026ndash;206. \u003c/li\u003e\n\u003cli\u003eHIV Management Guidelines [Internet]. [cited 2025 Jan 3]. Renal disorders in people with HIV infection. Available from: https://hiv.guidelines.org.au/management/renal-disorders-in-people-with-hiv-infection/\u003c/li\u003e\n\u003cli\u003eAbraham AG, Althoff KN, Jing Y, Estrella MM, Kitahata MM, Wester CW, et al. End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2015 Mar 15;60(6):941\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eChoi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Volberding PA, O\u0026rsquo;Hare AM. The impact of HIV on chronic kidney disease outcomes. Kidney Int. 2007 Dec 1;72(11):1380\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eCampos P, Ortiz A, Soto K. HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J. 2016 Dec 1;9(6):772\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eCouser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011 Dec;80(12):1258\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003ePost FA, Holt SG. Recent developments in HIV and the kidney. Curr Opin Infect Dis. 2009 Feb;22(1):43\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSwanepoel CR, Atta MG, D\u0026rsquo;Agati VD, Estrella MM, Fogo AB, Naicker S, et al. Kidney Disease in the Setting of HIV Infection: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2018 Mar;93(3):545\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eRosenberg AZ, Naicker S, Winkler CA, Kopp JB. HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment. Nat Rev Nephrol. 2015 Mar;11(3):150\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eKumar N, Perazella MA. Differentiating HIV-associated nephropathy from antiretroviral drug-induced nephropathy: a clinical challenge. Curr HIV/AIDS Rep. 2014 Sep;11(3):202\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eBig\u0026eacute; N, Lanternier F, Viard JP, Kamgang P, Daugas E, Elie C, et al. Presentation of HIV-associated nephropathy and outcome in HAART-treated patients. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2012 Mar;27(3):1114\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eHalle MP, Essomba N, Djantio H, Tsele G, Fouda H, Luma NH, et al. Clinical characteristics and outcome of HIV infected patients with chronic kidney disease in Sub Saharan Africa: an example from Cameroon. BMC Nephrol. 2019 Jul 9;20(1):253. \u003c/li\u003e\n\u003cli\u003eKlag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J. End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA. 1997 Apr 23;277(16):1293\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRostand SG, Kirk KA, Rutsky EA, Pate BA. Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med. 1982 May 27;306(21):1276\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eMwanjala MN, Urio LJ, Mtebe MV. Prevalence and predictors of renal dysfunction among people living with HIV on antiretroviral therapy in the Southern Highland of Tanzania: a hospital-based cross-sectional study. Pan Afr Med J. 2022 Feb 17;41:137. \u003c/li\u003e\n\u003cli\u003eAzagew AW, Abate HK, Ferede YM, Mekonnen CK. Acute kidney injury and its predictors among HIV-positive patients in Africa: Systematic review and meta-analysis. PLOS ONE. 2024 Feb 9;19(2):e0298302. \u003c/li\u003e\n\u003cli\u003eMekuria Y, Yilma D, Mekonnen Z, Kassa T, Gedefaw L. Renal Function Impairment and Associated Factors among HAART Na\u0026iuml;ve and Experienced Adult HIV Positive Individuals in Southwest Ethiopia: A Comparative Cross Sectional Study. PLoS ONE. 2016 Aug 18;11(8):e0161180. \u003c/li\u003e\n\u003cli\u003eCooper RD, Wiebe N, Smith N, Keiser P, Naicker S, Tonelli M. Systematic review and meta-analysis: renal safety of tenofovir disoproxil fumarate in HIV-infected patients. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010 Sep 1;51(5):496\u0026ndash;505. \u003c/li\u003e\n\u003cli\u003eDrak D, Shamu T, Heron JE, Chimbetete C, Dahwa R, Gracey DM. Renal function and associated mortality risk in adults commencing HIV antiretroviral therapy in Zimbabwe. AIDS Lond Engl. 2022 Apr 1;36(5):631\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eShi R, Chen X, Lin H, Ding Y, He N. Incidence of impaired kidney function among people with HIV: a systematic review and meta-analysis. BMC Nephrol. 2022 Mar 17;23(1):107. \u003c/li\u003e\n\u003cli\u003eAkinola AA, Aderemi-Williams RI, Onwuchuluba EE, Olumese ED, Dibie BC, Amira CO. Kidney function impairment among adult people living with HIV on antiretroviral therapy in South-West, Nigeria. Discov Viruses. 2024 Dec 19;1(1):5. \u003c/li\u003e\n\u003cli\u003eLucas GM, Atta MG, Zook K, Vaidya D, Tao X, Maier P, et al. Cross-Sectional and Longitudinal Performance of Creatinine- and Cystatin C-Based Estimating Equations Relative to Exogenously Measured Glomerular Filtration Rate in HIV-Positive and HIV-Negative Persons. J Acquir Immune Defic Syndr 1999. 2020 Dec 1;85(4):e58\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eIslam FM, Wu J, Jansson J, Wilson DP. Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis. BMC Public Health. 2012 Mar 23;12:234. \u003c/li\u003e\n\u003cli\u003eHIV-Associated Nephropathy and Other HIV-Related Renal Disorders: Practice Essentials, Pathophysiology, Epidemiology. 2025 Jan 2 [cited 2025 Jun 25]; Available from: https://emedicine.medscape.com/article/246031-overview\u003c/li\u003e\n\u003cli\u003ePontes PS, Ruffino-Netto A, Kusumota L, Costa CRB, Gir E, Reis RK. Factors associated to chronic kidney disease in people living with HIV/AIDS. Rev Lat Am Enfermagem. 28:e3331. \u003c/li\u003e\n\u003cli\u003eLopes JA, Melo MJ, Raimundo M, Fragoso A, Antunes F. Long-term risk of mortality for acute kidney injury in HIV-infected patients: a cohort analysis. BMC Nephrol. 2013 Feb 11;14(1):32. \u003c/li\u003e\n\u003cli\u003eMayor AM, Dworkin M, Quesada L, Rios-Olivares E, Hunter-Mellado RF. The Morbidity and Mortality Associated With Kidney Disease In An HIV Infected Cohort In Puerto Rico. Ethn Dis. 2010;20(1 0 1):S1-163\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGardner LI, Holmberg SD, Williamson JM, Szczech LA, Carpenter CCJ, Rompalo AM, et al. Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J Acquir Immune Defic Syndr 1999. 2003 Feb 1;32(2):203\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eMulenga L, Musonda P, Mwango A, Vinikoor MJ, Davies MA, Mweemba A, et al. Effect of baseline renal function on tenofovir-containing antiretroviral therapy outcomes in Zambia. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014 May;58(10):1473\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eWyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS Lond Engl. 2006 Feb 28;20(4):561\u0026ndash;5. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Kidney impairment, PLHIV, mortality risk, sub-urban hospital","lastPublishedDoi":"10.21203/rs.3.rs-7466658/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7466658/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe risk of kidney disease remains high in HIV-positive people, and kidney disease in people living with HIV (PLHIV) is associated with poor outcomes, including an increase in mortality. This study aimed to determine the prevalence of kidney impairment and its associated mortality risk in PLHIV admitted at Buea Regional Hospital (BRH), Cameroon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA 5-year retrospective study was carried out at the BRH. Files of admitted HIV patients aged 18 or older from 01st January 2017 to 31st December 2021 were included. Demographic and clinical data were extracted. Renal function impairment was defined as eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60 ml/min/1.73 m\u0026sup2; using MDRD (modification of diet in renal disease) equation. All serum creatinine levels were performed using the colorimetric method. Data were analysed using SPSS (statistical package for the social sciences) version 25. Bivariate and multivariate logistic regressions were performed to identify the association between the presence of kidney impairment and mortality. Statistical significance was set at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with a confidence interval of 95%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWe included a total of 890 patients, of whom 201 patients had kidney impairment, a prevalence of 26.1% with a male to female ratio of 1.008. The mean age of participants with kidney impairment was higher than those without, 46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years and 42.9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1 years, respectively (P\u0026thinsp;=\u0026thinsp;0.001). The mortality rate among patients with kidney disease was statistically significantly higher (34.8%) compared to those without (23.5%). Participants with kidney impairment had statistically significantly higher odds of death during hospitalisation compared to those without kidney impairment (AOR\u0026thinsp;=\u0026thinsp;1.55, 95% CI 1.04\u0026ndash;2.32).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe prevalence of kidney impairment among admitted HIV-positive patients was considerably high, and the risk of death was higher in patients with kidney impairment compared to those without. These findings should prompt earlier screening, closer monitoring and follow-up of kidney disease among PLHIV.\u003c/p\u003e","manuscriptTitle":"Prevalence of Kidney Impairment and Mortality Among People Living With Hiv Admitted in a Sub-urban Hospital in Cameroon: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 09:24:42","doi":"10.21203/rs.3.rs-7466658/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-23T07:40:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T17:15:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15304813683439146272864557277633035248","date":"2026-03-28T20:41:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T14:09:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137513479835643408912176718709123999312","date":"2026-03-24T16:22:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-05T08:41:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-30T10:20:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T11:57:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-01T15:41:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-01T15:37:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d9b2e3f-1470-4b47-893b-d552acff7710","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55240521,"name":"Health sciences/Diseases"},{"id":55240522,"name":"Health sciences/Medical research"},{"id":55240523,"name":"Health sciences/Nephrology"},{"id":55240524,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-21T10:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 09:24:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7466658","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7466658","identity":"rs-7466658","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}