Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients?
Background: Tenofovir disoproxil fumarate (TDF) is the recommended first-line nucleoside reverse transcriptase inhibitor (NRTI) in the management of human immunodeficiency virus (HIV); however, its use is associated with nephrotoxicity. Aim: To assess if the risks of renal impairment were similar in...
| Main Authors: | , , , , , , , , |
|---|---|
| Formato: | Artigo |
| Publicado em: |
Wiley
2018
|
| Assuntos: |
| _version_ | 1825721679631876096 |
|---|---|
| author | Low, Joo Zheng Khoo, Su Pei Nor Azmi, Nuruljannah Chong, Meng Li Sulaiman, Helmi Azwa, Iskandar Tan, Ching Hooi Kamarulzaman, Adeeba Rajasuriar, Reena |
| author_facet | Low, Joo Zheng Khoo, Su Pei Nor Azmi, Nuruljannah Chong, Meng Li Sulaiman, Helmi Azwa, Iskandar Tan, Ching Hooi Kamarulzaman, Adeeba Rajasuriar, Reena |
| author_sort | Low, Joo Zheng |
| collection | UM |
| description | Background: Tenofovir disoproxil fumarate (TDF) is the recommended first-line nucleoside reverse transcriptase inhibitor (NRTI) in the management of human immunodeficiency virus (HIV); however, its use is associated with nephrotoxicity. Aim: To assess if the risks of renal impairment were similar in treatment-naïve compared to treatment-experienced patients initiating tenofovir given their different background clinical characteristics. Method: This was a retrospective observational study conducted at the University Malaya Medical Centre, Malaysia and included all HIV-infected adults who received tenofovir for at least 3 months and had an estimated glomerular filtration rate (eGFR) >60 mL/min at tenofovir initiation. The incidence of renal impairment was defined as a 25% decrease in eGFR from baseline or the development of chronic kidney disease. Clinical and demographic characteristics were extracted from medical records. Risk factors associated with tenofovir-induced renal impairment were determined using multivariate logistic regression. Results: This study included 314 patients and almost half of them (49%) were treatment-naïve at tenofovir initiation. The majority of patients were male (89.5%) with a median (interquartile range) baseline creatinine clearance of 99.1 mL/min (85.0–114.0). Thirty (9.4%) patients developed tenofovir-induced renal impairment and the incidence rate was higher in treatment-experienced versus treatment-naïve patients (7.0 vs 3.3 cases/100 person-years, p = 0.049). Risk factors associated with tenofovir-induced nephrotoxicity in multivariate analysis were older age (p = 0.001), anaemia (p = 0.027), concurrent hypertension (p = 0.014) and higher baseline eGFR (p = 0.007). Conclusion: Treatment experience was not an independent risk factor but was rather confounded by multiple characteristics associated with an increased risk of TDF-induced nephrotoxicity. Monitoring all patients presenting with these risks regardless of treatment experience is crucial. |
| first_indexed | 2024-03-06T05:54:02Z |
| format | Article |
| id | um.eprints-21392 |
| institution | Universiti Malaya |
| last_indexed | 2024-03-06T05:54:02Z |
| publishDate | 2018 |
| publisher | Wiley |
| record_format | dspace |
| spelling | um.eprints-213922019-05-29T04:28:42Z http://eprints.um.edu.my/21392/ Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? Low, Joo Zheng Khoo, Su Pei Nor Azmi, Nuruljannah Chong, Meng Li Sulaiman, Helmi Azwa, Iskandar Tan, Ching Hooi Kamarulzaman, Adeeba Rajasuriar, Reena R Medicine Background: Tenofovir disoproxil fumarate (TDF) is the recommended first-line nucleoside reverse transcriptase inhibitor (NRTI) in the management of human immunodeficiency virus (HIV); however, its use is associated with nephrotoxicity. Aim: To assess if the risks of renal impairment were similar in treatment-naïve compared to treatment-experienced patients initiating tenofovir given their different background clinical characteristics. Method: This was a retrospective observational study conducted at the University Malaya Medical Centre, Malaysia and included all HIV-infected adults who received tenofovir for at least 3 months and had an estimated glomerular filtration rate (eGFR) >60 mL/min at tenofovir initiation. The incidence of renal impairment was defined as a 25% decrease in eGFR from baseline or the development of chronic kidney disease. Clinical and demographic characteristics were extracted from medical records. Risk factors associated with tenofovir-induced renal impairment were determined using multivariate logistic regression. Results: This study included 314 patients and almost half of them (49%) were treatment-naïve at tenofovir initiation. The majority of patients were male (89.5%) with a median (interquartile range) baseline creatinine clearance of 99.1 mL/min (85.0–114.0). Thirty (9.4%) patients developed tenofovir-induced renal impairment and the incidence rate was higher in treatment-experienced versus treatment-naïve patients (7.0 vs 3.3 cases/100 person-years, p = 0.049). Risk factors associated with tenofovir-induced nephrotoxicity in multivariate analysis were older age (p = 0.001), anaemia (p = 0.027), concurrent hypertension (p = 0.014) and higher baseline eGFR (p = 0.007). Conclusion: Treatment experience was not an independent risk factor but was rather confounded by multiple characteristics associated with an increased risk of TDF-induced nephrotoxicity. Monitoring all patients presenting with these risks regardless of treatment experience is crucial. Wiley 2018 Article PeerReviewed Low, Joo Zheng and Khoo, Su Pei and Nor Azmi, Nuruljannah and Chong, Meng Li and Sulaiman, Helmi and Azwa, Iskandar and Tan, Ching Hooi and Kamarulzaman, Adeeba and Rajasuriar, Reena (2018) Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? Journal of Pharmacy Practice and Research, 48 (3). pp. 242-250. ISSN 1445-937X, DOI https://doi.org/10.1002/jppr.1392 <https://doi.org/10.1002/jppr.1392>. https://doi.org/10.1002/jppr.1392 doi:10.1002/jppr.1392 |
| spellingShingle | R Medicine Low, Joo Zheng Khoo, Su Pei Nor Azmi, Nuruljannah Chong, Meng Li Sulaiman, Helmi Azwa, Iskandar Tan, Ching Hooi Kamarulzaman, Adeeba Rajasuriar, Reena Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title | Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title_full | Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title_fullStr | Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title_full_unstemmed | Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title_short | Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients? |
| title_sort | is the risk of tenofovir induced nephrotoxicity similar in treatment naive compared to treatment experienced patients |
| topic | R Medicine |
| work_keys_str_mv | AT lowjoozheng istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT khoosupei istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT norazminuruljannah istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT chongmengli istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT sulaimanhelmi istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT azwaiskandar istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT tanchinghooi istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT kamarulzamanadeeba istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients AT rajasuriarreena istheriskoftenofovirinducednephrotoxicitysimilarintreatmentnaivecomparedtotreatmentexperiencedpatients |