Correlation Between Anaemia and Renal Dysfunction in HIV-Positive Patients Receiving Tenofovir-Based Antiretroviral Therapy at Marondera Provincial Hospital from 2020 to 2025

Abstract

Tenofovir Disoproxil Fumarate (TDF), a key component of antiretroviral therapy (ART) in Zimbabwe, has been associated with nephrotoxicity, but its specific, concurrent impact on anaemia and the role of treatment duration are not well-quantified locally. The main objective of this study was to investigate the correlation between anaemia and renal dysfunction in HIV-positive patients receiving TDF-based ART at Marondera Provincial Hospital, considering data from 2020-2025. A retrospective cross-sectional analysis was conducted on 600 patient records. The variables of interest were ART duration, haemoglobin (Hb), serum creatinine, and estimated glomerular filtration rate (eGFR); the outcomes were the prevalence and severity of anaemia and renal dysfunction. The prevalence of any renal impairment (eGFR < 90) was 42.3%, with 6.8% of patients exhibiting moderate-to-severe dysfunction (eGFR < 60). The prevalence of anaemia (any stage) was 27.2%. A statistically significant, moderate positive correlation was found between haemoglobin and eGFR (r = 0.420, p < .001), while a weaker negative correlation was observed with serum creatinine (r = -0.245, p < .001). Critically, the duration of TDF-based ART was significantly associated with the severity of both renal impairment (F(4, 595) = 5.93, p = .0001) and anaemia (F(3, 596) = 4.87, p = .0024). A review of group means demonstrated a clear trend, with mean ART duration progressively increasing from 38.4 months in the normal renal function group to 52.1 months in the end-stage group, and similarly from 39.1 months in the normal haemoglobin group to 48.7 months in the severe anaemia group. These findings suggest a cumulative, duration-dependent toxicity from TDF, which likely causes anaemia via impaired erythropoietin production secondary to renal damage. The data confirms eGFR is a more sensitive marker for this systemic complication than creatinine alone. The study recommends the implementation of integrated monitoring protocols, including regular eGFR and Hb screening, particularly for patients on TDF-based ART for over three years.