Prevalence and factors associated with renal impairment among people living with HIV: findings from a nested study in the CHAO cross-sectional cohort in Meru County, Kenya

Introduction: Renal impairment is a growing concern among people living with HIV (PLWH), particularly in sub-Saharan Africa. While previous studies identified risk factors such as advanced age, reduced CD4 counts, and high viral loads, demographic and clinical determinants remain underexplored. This study evaluates the prevalence of renal impairment and associated factors in PLWH on ART in Meru County, Kenya. Methods: This nested sub-analysis of the CHAO cross-sectional cohort examines renal health outcomes. Participants were adults (≥ 18 years) living with HIV with available renal function data. Data collection included demographics, duration of ART treatment, and comorbidities. Renal function was assessed using estimated glomerular filtration rate (eGFR, expressed in mL/min/1.73 m²). Renal impairment was defined as eGFR < 60 mL/min/1.73 m². Logistic regression models were used to assess factors associated with renal impairment. Ethical approval and informed consent were obtained. Results: Among 1,042 participants, 33.4% (95% CI: 30.5–36.3%) had renal impairment (eGFR < 60 mL/min/1.73 m²). Advancing age significantly increased the odds of renal impairment (aOR 1.24 per 5 years, p < 0.001). Female participants had nearly fivefold higher odds (aOR 4.76, p < 0.001). Dyslipidemia was also associated with increased risk (aOR 1.12 per 10-unit cholesterol increase, p < 0.001). Conclusion: Renal impairment is prevalent among HIV-positive individuals, especially older women and those with metabolic comorbidities. Findings highlight the need for targeted renal monitoring and integrated HIV and non-communicable disease management to reduce renal impairment in resource-limited settings.