Prevalence of Acute Kidney Injury and its predictors among HIV Positive Patients in Africa: Systematic Review and Meta-Analysis

Background: Acute kidney injury(AKI) is a rapid loss of the kidney’s excretory function, resulting in an accumulation of end products of nitrogen metabolism. Even though there were studies that reported the prevalence of AKI among HIV-positive patients in Africa, their findings were inconsistent in terms of prevalence of AKI and its predictors across the studies. Therefore, this review study aimed to determine the pooled prevalence of AKI and its predictors. Methods: We searched on PubMed, Embas, Ebsco, OVID, Cochrane Library, and other supplementary search engines, including Google and Google Scholar. Articles published up to July 2023 were included in this review study. The quality of the study was assessed using the Newcastle-Ottawa Scale for cross-sectional, case-control, and cohort studies. The data were extracted using a Microsoft Excel spreadsheet and exported to Stata version 14 for analysis. A random effect meta-analysis model was used to estimate the pooled prevalence of AKI among HIV-positive patients. Heterogeneity was evaluated using Cochrane Q statistics and I squared (I2). Furthermore, the graphic asymmetric test of the funnel plot and/or Egger’s tests were computed to detect publication bias. To treat the publication bias, a trim and fill analysis was carried out. The protocol of this review has been registered in an international database, the Prospective Register of Systematic Reviews (PROSPERO), with reference number CRD42023446078. .Results: A total of twenty-four original articles comprising 7913HIV-positive patients were included in the study. The pooled prevalence of AKI among HI-positive patients was found to be 23.35% (95% CI: 18.14-28.56%, I2 = 97.7%, p-value <0.001). Low hemoglobin (Hgb <8mg/dl) was found to be the determinant factor for AKI among HIV-positive patients (AOR = 2.4; 95% CI:1.69-3.4, I2 = 0.0%, p-value = 0.40). In meta-regression analysis, sample size was the possible source of variation among the included studies (AOR = 3.11, 95%CI: 2.399-3.83). Conclusions: This review investigated the pooled prevalence of AKI and its predictors. Therefore, the pooled prevalence of AKI among HIV-positive patients was high. Having low level of hemoglobin levels were the risk of developing AKI among HIV positive patients. Keywords: Acute kidney injury, renal dysfunction, renal impairment, HIV, Africa