Incidence and Risk Factors of Tenofovir Disoproxil Fumarate Induced Nephrotoxicity and Renal Function Recovery, a Hospital Case-Control Study

Srisopa Sirikan; Kornjirakasemsan Akarawat; Treebupachatsakul Pornpit; Sonthisombat Paveena

doi:10.3947/ic.2023.0001

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저자정보: Srisopa Sirikan (The College of Pharmacotherapy of Thailand The Pharmacy Council of Thailand Nonthaburi Thailand.Department of Pharmaceutical Science Naresuan University Phitsanulok Thailand.) Kornjirakasemsan Akarawat (Pharmacy Department Nakornping Hospital Chiang Mai Thailand.) Treebupachatsakul Pornpit (Department of Internal Medicine Buddhachinaraj Hospital Phitsanulok Thailand.) Sonthisombat Paveena (Department of Pharmaceutical Science Naresuan University Phitsanulok Thailand.)

저널정보: 대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제55권 제2호

발행연도: 2023.6

수록면: 226 - 236 (11page)

DOI: 10.3947/ic.2023.0001

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Background The incidence of tenofovir disoproxil fumarate (TDF)-induced nephrotoxicity ranges from 15.8 to 19.3 percent. Following cessation of TDF, approximately one-half of patients with nephrotoxicity regained full renal functions. This study aimed to determine the incidence and risk factors for nephrotoxicity, as well as the complete recovery of renal function, in human immunodeficiency virus (HIV)-infected patients receiving TDF regimens. Materials and Methods This was a retrospective case-control study of HIV-positive patients who received TDF regimens from 2 tertiary hospitals between 2012 and 2018. Signs of TDF-induced renal dysfunction, defined as having estimated glomerular filtration rate (eGFR) decline of greater than 25%, and proximal renal tubulopathy (PRT) were followed for 48 months. After discontinuing TDF due to nephrotoxicity, the renal parameters of patients were monitored for 48 months. Univariate and multivariate regression analyses were used to determine the factors associated with TDF-induced nephrotoxicity and renal function recovery. Results Twelve percent of 3,214 TDF-treated patients were diagnosed with renal dysfunction, whereas 303 patients (15.20%) were diagnosed with PRT. TDF-induced renal dysfunction was associated with older age (odds ratio [OR] = 2.851), smoking (OR = 1.972), and TDF use for more than 3 years (OR 1.928). Receiving trimethoprim-sulfamethoxazole (TMP/SMX) or nonsteroidal anti-inflammatory drugs (NSAIDs) and being elderly were associated with PRT (OR = 4.727, 4.313, and 3.357, respectively). Following the discontinuation of TDF, 12.96% of patients regained full renal function. Elderly patients and those taking renin-angiotensin-aldosterone system (RAAS) inhibitors or protease inhibitors (PIs) had a lower likelihood of full recovery (OR = 0.811, 0.793, 0.582, respectively). One-third experienced PRT recovery, whereas RAAS inhibitors use, old age, and receiving PIs decreased the likelihood of PRT recovery (OR = 0.709, 0.504, 0.311, respectively). TDF cessation at an eGFR greater than 60 mL/min/1.73 m2 increased the likelihood of renal function recovery and PRT by 4.07 and 2.11 times, respectively. Conclusion Twelve percent and 15 percent of patients receiving TDF developed renal dysfunction and PRT, respectively. Age, TMP/SMX, NSAIDs, and long-term TDF exposure were independent risk factors for TDF-induced nephrotoxicity. Thirteen and thirty-three percent of patients with renal dysfunction and PRT recovered from their conditions, respectively. The discontinuation of TDF at an eGFR greater than 60 mL/min/1.73 m2 was advantageous for the recovery of renal function and PRT.

Background The incidence of tenofovir disoproxil fumarate (TDF)-induced nephrotoxicity ranges from 15.8 to 19.3 percent. Following cessation of TDF, approximately one-half of patients with nephrotoxicity regained full renal functions. This study aimed to determine the incidence and risk factors for nephrotoxicity, as well as the complete recovery of renal function, in human immunodeficiency virus (HIV)-infected patients receiving TDF regimens. Materials and Methods This was a retrospective case-control study of HIV-positive patients who received TDF regimens from 2 tertiary hospitals between 2012 and 2018. Signs of TDF-induced renal dysfunction, defined as having estimated glomerular filtration rate (eGFR) decline of greater than 25%, and proximal renal tubulopathy (PRT) were followed for 48 months. After discontinuing TDF due to nephrotoxicity, the renal parameters of patients were monitored for 48 months. Univariate and multivariate regression analyses were used to determine the factors associated with TDF-induced nephrotoxicity and renal function recovery. Results Twelve percent of 3,214 TDF-treated patients were diagnosed with renal dysfunction, whereas 303 patients (15.20%) were diagnosed with PRT. TDF-induced renal dysfunction was associated with older age (odds ratio [OR] = 2.851), smoking (OR = 1.972), and TDF use for more than 3 years (OR 1.928). Receiving trimethoprim-sulfamethoxazole (TMP/SMX) or nonsteroidal anti-inflammatory drugs (NSAIDs) and being elderly were associated with PRT (OR = 4.727, 4.313, and 3.357, respectively). Following the discontinuation of TDF, 12.96% of patients regained full renal function. Elderly patients and those taking renin-angiotensin-aldosterone system (RAAS) inhibitors or protease inhibitors (PIs) had a lower likelihood of full recovery (OR = 0.811, 0.793, 0.582, respectively). One-third experienced PRT recovery, whereas RAAS inhibitors use, old age, and receiving PIs decreased the likelihood of PRT recovery (OR = 0.709, 0.504, 0.311, respectively). TDF cessation at an eGFR greater than 60 mL/min/1.73 m2 increased the likelihood of renal function recovery and PRT by 4.07 and 2.11 times, respectively. Conclusion Twelve percent and 15 percent of patients receiving TDF developed renal dysfunction and PRT, respectively. Age, TMP/SMX, NSAIDs, and long-term TDF exposure were independent risk factors for TDF-induced nephrotoxicity. Thirteen and thirty-three percent of patients with renal dysfunction and PRT recovered from their conditions, respectively. The discontinuation of TDF at an eGFR greater than 60 mL/min/1.73 m2 was advantageous for the recovery of renal function and PRT.

#Tenofovir disoproxil fumarate #Nephrotoxicity #Proximal tubular dysfunction #Recovery of renal function

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Srisopa Sirikan

소속기관 The College of Pharmacotherapy of Thailand The Pharmacy Council of Thailand Nonthaburi Thailand.Department of Pharmaceutical Science Naresuan University Phitsanulok Thailand.

주요연구분야 의약학 > 임상의학 > 내과학

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Kornjirakasemsan Akarawat

소속기관 Pharmacy Department Nakornping Hospital Chiang Mai Thailand.

주요연구분야 의약학 > 임상의학 > 내과학

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Treebupachatsakul Pornpit

소속기관 Department of Internal Medicine Buddhachinaraj Hospital Phitsanulok Thailand.

주요연구분야 의약학 > 임상의학 > 내과학

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Sonthisombat Paveena

소속기관 Department of Pharmaceutical Science Naresuan University Phitsanulok Thailand.

주요연구분야 의약학 > 임상의학 > 내과학

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