Prevalence and multimodal factors associated with impaired kidney function among persons with and without HIV in a routine clinic setting: a cross-sectional study

This cross-sectional study aimed to determine the prevalence and factors associated with impaired kidney function (IKF), defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², in a mixed HIV serostatus cohort attending a routine care clinic at Livingstone University Teaching Hospital in Zambia. The overall prevalence of IKF was 12.0% (29/241) and was significantly higher in people living with HIV (PLWH) than those without (17.0% vs. 4.3%, p = 0.003). Sequential multivariable analyses revealed consistent associations. Multivariable analysis using a data-driven Firth’s penalized-likelihood logistic regression model identified HIV infection (Adjusted Odds Ratio [AOR] = 7.04; 95% CI 2.15–22.94; p = 0.001), increased interventricular septum diameter in diastole (AOR = 39.56; 95% CI 5.20-300.80; p = 0.0003), increased right ventricular dimension in diastole (AOR = 6.01; 95% CI 1.64–22.03; p = 0.007), and higher serum uric acid levels (AOR = 1.01 per mmol/L; 95% CI 1.00-1.01; p = 0.009) to be independently associated with IKF. A clinical model confirmed associations with older age, HIV, and higher fasting blood sugar. When adjusting for these clinical factors, higher levels of soluble ST2, uric acid, and spot microalbumin remained significantly associated with IKF. This study reveals a high burden of undetected kidney impairment in a routine clinic setting, disproportionately affecting PLWH. These findings warrant validation in larger prospective studies.