Prevalence and Factors Associated with Renal Dysfunction Among Older Kenyan Women Living with HIV

Abstract

BackgroundAs people living with HIV age, chronic comorbidities such as renal dysfunction are becoming increasingly important contributors to morbidity and mortality. Older adults living with HIV may be at increased risk for renal impairment due to aging, long-term antiretroviral therapy (ART) exposure, chronic inflammation, and socioeconomic factors. However, limited data exist among older women living with HIV in sub-Saharan Africa. Methods This cross-sectional study analyzed data from older Kenyan women living with HIV enrolled in the Women Aging with HIV study. The analytical sample was restricted to 188 participants with complete laboratory data. Serum creatinine values exceeding 91.9 µmol/L were classified as abnormally elevated, and overall renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² using the Modification of Diet in Renal Disease (MDRD) equation. Demographic, socioeconomic, clinical, and treatment-related variables were evaluated. Univariable logistic regression models estimated unadjusted odds ratios (ORs), and multivariable logistic regression models calculated age-adjusted odds ratios (aORs). Results Among the cohort, 46.8% (88/188) met the criteria for renal dysfunction, and 81.5% (163/188) exhibited continuous creatinine levels above standard reference ranges. Increasing age was heavily associated with renal dysfunction; participants aged 70 years and older had a more than four-fold unadjusted odds of renal dysfunction compared to those younger than 60 (OR = 4.44; 95% CI: 1.45–16.62). Ever-married status was strongly protective against renal dysfunction in the age-adjusted model (aOR = 0.35; 95% CI: 0.15–0.77). Current employment was associated with lower unadjusted odds (OR = 0.53; 95% CI: 0.29–0.94), but lost statistical significance after controlling for age. Regarding clinical factors, long-term treatment stabilization was strongly protective, with an ART duration of >10 years demonstrating a significant 69% reduction in age-adjusted odds of renal disease (aOR = 0.31; 95% CI: 0.11–0.78). Education, housing variables, viral suppression, diabetes, hypertension, and TDF exposure were not significantly associated with renal dysfunction in adjusted models. Conclusion These findings underscore an urgent need to expand systematic renal dysfunction monitoring within aging HIV care infrastructures. Renal dysfunction and elevated creatinine are highly prevalent among older Kenyan women living with HIV, driven primarily by advanced chronological age. Conversely, protective associations with a history of marital partnership and an ART duration exceeding 10 years highlight how deeply structural social frameworks and long-term therapeutic continuity influence objective health outcomes. Incorporating these socioeconomic and treatment-related milestones into holistic clinical risk profiles will be essential to identify vulnerable individuals and preserve long-term kidney health in this aging population.