OUTCOME OF ACUTE PERITONEAL DIALYSIS IN HIV PATIENTS WITH RENAL INSUFFICIENCY –PILOT EXPERIENCE FROM A LOW -MIDDLE INCOME COUNTRY.

Introduction:

Renal impairment in HIV infected patients are a major cause of morbidity and mortality.The prevalence of CKD among PLHIV is 6.4%,with 7.9% in Africa, 7.1% in North America, 5.7%  Asia and 3.7% in  Europe. AKI has been increasing in HIV infected patients by 2-3 times ,with pre existing CKD being an important   risk factor.Very few studies have been based on prevalence and risk factors influencing renal disease in HIV population. However, studies on modality of dialysis, and their outcome in ESRD cases are limited. Hence the study aimed to analyse the clinical profile and assess the outcome of acute peritoneal dialysis in HIV patients with renal insufficiency  in a resource limited setting.

Methods:

This was an observational study conducted  in  department of nephrology in government tertiary care hospital which included all HIV patients admitted to critical care unit with renal insufficiency between January  2019 and September 2023.Demographic, clinical and laboratory parameters of  the study population were noted. The causes of admission noted. Duration of peritoneal dialysis and complications were noted. Outcome status assessed and the factors responsible for mortality were analysed.The Primary outcome assessed was mortality and Secondary outcome assessed was Recovery of renal function, as complete, partial and non recovered status.The treatment protocol , and study population were as follows

Results:

Among 136 patients on acute peritoneal dialysis(PD), mean age was 45.5+/-11.9years,with males constituting 68.3% (93) and females of 31.6%(43). 66 patients were diagnosed to have Acute kidney injury(AKI) ,44 with acute on chronic kidney disease(CKD) and 26 of CKD5 on dialysis (CKD5D).The predominant causes of admission were sepsis with multiorgan dysfunction in AKI(30.3%) and acute on CKD(31.8%) and pneumonia(23%) in CKD5D.WIth respect to PD , complications like peritonitis (62%), mechanical issues of leakage(54%) and hypokalemia (45.8%) were found more in CKD5D and they had higher mortality of 84%, when compared to mortality of AKI(27%) and acute on CKD(40.9%)(p-0.002). Nonsurvivors(58)  were found to be with Obesity, long HIV duration, History of tuberculosis and hcv confection,low hemoglobin and albumin, with sepsis with organ dysfunction, pneumonia and urinary tract infection(p below 0.05). Renal recovery was not attained in 45.8% of AKI and 46.1% of acute on CKD (p 0.003).The following are the tabulations of above results.

Conclusions:

Studies on HIV patients with acute peritoneal dialysis are sparse.

• In Low and middle income countries, Acute Intermittent Peritoneal Dialysis  is the effective modality of RRT in HIV patients.

• Infectious etiologies are the major causes of AKI and acute deterioration of CKD in  HIV population.

• HIV on maintanence hemodialysis have high mortality and poor prognosis.

•The  factors influencing mortality are duration of HIV  status, CD4  count, TB status, HCV coinfection, Obesity, Anemia and  Hypoalbuminemia.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.