ROLE OF ACUTE PERITONEAL DIALYSIS IN HIV PATIENTS WITH RENAL INSUFFICIENCY –A STUDY FROM A LOW AND MIDDLE INCOME COUNTRY.

Renal impairment in HIV infected patients are a major cause of morbidity and mortality.The prevalence of Chronic Kidney diseases(CKD) among Patient living with HIV (PLHIV) is 6.4%,with 7.9% in Africa, 7.1% in North America, 5.7%  Asia and 3.7% in  Europe. Acute Kidney Injury(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 this study was  to analyse the clinical profile and assess the outcome of acute peritoneal dialysis in HIV patients with renal insufficiency  in a resource limited setting

Study design:  Observational study.

Study period: January 2019 to September 2023

Study setting: Department of Nephrology ,Government tertiary care hospital,India

Inclusion criteria:   All HIV patients who are admitted to critical care unit with renal insufficiency.

Exclusion criteria:Patients, admitted with(1)isolated proteinuria(2)isolated  Hypertension (3)and without renal failure.

Study population: 191 HIV cases with renal insufficiency, of which 136 patients underwent Acute Peritoneal dialysis

Methodology : Demographic, clinical and laboratory parameters of  the study population were noted. The causes of admission noted. Duration of peritoneal dialysis and complications were noted.Patients were categorised into AKI, CKD3-5ND(nondialytic) andCKD5D (dialytic), as per the standard definitions by Kidney Diseases Improving Global Outcome (KDIGO) guidelines.Outcome status assessed and the factors responsible for mortality were analysed.The Primary outcome assessed was mortality. The Secondary outcome assessed was Recovery of renal function, as complete, partial and nonrecovered status.HIV with renal failure cases are managed in our centre with acute peritoneal dialysis alone and the other extracorporeal modalities of Hemodialysis and CRRT are not provided in view of lack of resources. the treatment protocol of our centre is as follows: Any HIV with renal failure irrespective of hemodynamic status( except abdominal surgeries, perforation,etc) were managed with acute PD, for 7 days,through rigid PD catheter, with manual exchanges each with  dwell volume of 1L Dextrose (1.7%), dwell time of 40 min and followed by out of 20 min and net ultrafiltrate assessed over 24 hours each day.After which, those dialysis independent were discharged and those dependent , were given the option of either conversion to Hemodialysis/CAPD or Redo acute PD after gap of 2 days after assessing PD fluid cell count and culture.

The total HIV admissions over the last 4 years (2019-2023) in our centre was 2055 cases. Of them 191 patients (9.29%) were diagnosed with renal insufficiency. This accounts to 2.73% of our total inpatients in our nephrology department(6980).AKI, CKD3-5ND AND CKD5D constituted 100(52.3%),60 (31.4%) and 26(13.1%) of the study population respectively. 51 patients(26.7%) were conservatively managed, 2 cases(1.05%) underwent HD and 2(1.05%)had CAPD. Of 191 cases, 136 cases(71.2%) underwent PD . hence the study population.

Table 1: General characteristics -With respect to categories:-