Acute Kidney Injury: A comparative study of outcomes in human immunodeficiency virus- positive and human immunodeficiency virus- negative patients

Abstract

Background: The intersection between HIV/AIDS and renal health is critical in South Africa for multifactorial reasons. We aimed to compare the renal outcomes in HIV subsets on dialysis for AKI. Methods: This retrospective study was at Chris Hani Baragwanath Academic Hospital (CHBAH) renal unit, between January and December 2017. Records of 103 patients above 18 years who received dialysis for AKI irrespective of their HIV status were examined. The KDIGO criteria were used to define AKI and renal outcomes included renal recovery, progression to CKD, or death. We determined the clinical causes of AKI and renal outcomes stratified by HIV status. Data was analysed using RStudio 2023.09.1 Build 494 and a P value of ≤0.05 considered significant. Results: Mean age of the study population was 39.5±12.4 years, male: female ratio of 1:1.2. Majority were African (93.2%), being HIV-positive (48.5%) versus HIV-negative (46.6%) patients and five (4.9%) of unknown HIV status. Categories of AKI were 86.4% medical, 11.6% surgical and 2.0% obstetric. Renal outcomes were not significantly different in HIV patient groups. Higher urea, creatinine, potassium and phosphate, plus lower sodium and chloride were observed with poor outcomes (P < 0.05). Those with shorter duration on dialysis had a poorer outcome [37±52 days (alive) versus 7±7 days (demised) (P = 0.000)]. Conclusion: HIV remains a risk factor for AKI in South Africa. Electrolyte abnormalities may worsen AKI outcomes. We suggest further studies to unravel how HIV infection affects AKI outcomes.