Acute Kidney Injury, Risk Factors, and Prognosis in Hospitalized HIV-Infected Adults in South Africa, Compared by Tenofovir Exposure

Seedat, Faheem; Martinson, Neil; Motlhaoleng, Katlego; Abraham, Pattamukkil; Mancama, D; Naicker, Saraladevi; Variava, Ebrahim

doi:10.1089/aid.2016.0098

Cited by 17 publications

(14 citation statements)

References 37 publications

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“…A recent study in South Africa showed an incidence of renal impairment of a little below 3% during the first 12 months of TDF-containing ART in primary care populations, 29 while another South African study of patients hospitalised with AKI reported TDF therapy to be associated with more rapid worsening of renal function, a higher likelihood of proteinuria and acidosis, and delayed renal recovery. 30 The latter study highlights the poor prognosis of AKI in HIV-infected individuals in the context of limited access to renal replacement therapy, as more than a quarter of the patients in this cohort died. 30 …”

Section: Tenofovir Disoproxil Fumarate-associated Nephrotoxicitymentioning

confidence: 79%

“… 30 The latter study highlights the poor prognosis of AKI in HIV-infected individuals in the context of limited access to renal replacement therapy, as more than a quarter of the patients in this cohort died. 30 …”

Section: Tenofovir Disoproxil Fumarate-associated Nephrotoxicitymentioning

confidence: 79%

“… 34 The large number of patients co-infected with Mycobacterium tuberculosis may also contribute to increased risk because of rifampicin-related nephrotoxicity and interstitial nephritis induced by immune reconstitution inflammatory syndrome. 30 …”

Section: Risk Factors For Tenofovir Disoproxil Fumarate-associated Nementioning

confidence: 99%

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Approach to acute kidney injury in HIV-infected patients in South Africa

Boswell¹,

Rossouw²

2017

South. Afr. j. HIV med.

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BackgroundHIV-infected patients have an increased risk of renal disease. Current first-line antiretroviral therapy contains tenofovir disoproxil fumarate (TDF), which has nephrotoxic potential, characterised by proximal tubular cell injury. This may result in acute kidney injury, chronic kidney disease or partial or complete Fanconi syndrome.ObjectivesWe reviewed the existing literature on acute kidney injury and TDF-associated nephrotoxicity with the aim of providing an approach to diagnosis and management, which is relevant to a general medical practitioner.MethodsWe performed a broad literature search of biomedical databases including PubMed and ScienceDirect. Our search terms included, but were not limited to, ‘tenofovir’, ‘nephrotoxicity’, ‘HIV’, ‘acute kidney injury’ and ‘renal tubular acidosis’.Our aim was not to generate a systematic literature review with weighted evidence, but rather to provide a review of best practice from a variety of sources. Where published studies were not available from the above databases, we relied on relevant textbooks and professional guidelines.ResultsPotential nephrotoxicity is not an impediment to the widespread use of TDF in treating HIV infection, because most patients will tolerate the medication well. However, patients with advanced disease, low body weight, advanced age, pre-existing kidney disease and concomitant use of other nephrotoxic medications are at increased risk of adverse renal events and may develop severe complications if not appropriately managed. These risk factors are unfortunately common in patients initiating antiretroviral therapy in South Africa.ConclusionPrevention of renal damage by means of careful screening and monitoring of high-risk patients is of paramount importance. Increased awareness of this problem and knowledge of how to manage kidney disease should be emphasised for general medical practitioners who work with HIV-infected patients.

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Section: Tenofovir Disoproxil Fumarate-associated Nephrotoxicitymentioning

confidence: 79%

Section: Tenofovir Disoproxil Fumarate-associated Nephrotoxicitymentioning

confidence: 79%

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Approach to acute kidney injury in HIV-infected patients in South Africa

Boswell¹,

Rossouw²

2017

South. Afr. j. HIV med.

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“…Table 3 summarises the findings and conclusions made by the various authors from their studies. About 90% of the studies focused on chronic outcomes of kidney function in patients on TDF-containing ART while two reported on acute outcomes [34, 35, 51]. Most of the studies reported at least some incidence of RD in the patients taking TDF containing ART.…”

Section: Resultsmentioning

confidence: 99%

Tenofovir-associated kidney disease in Africans: a systematic review

et al. 2019

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Background Data on chronic kidney disease development in HIV infection is important towards building a comprehensive knowledge of HIV, ageing and polypharmacy in Africa. Several previous studies on tenofovir-associated kidney disease in Africa have shown conflicting results. This review summarises what is known about the development of kidney disease in HIV-positive African patients on tenofovir disoproxil fumarate (TDF)-containing ART. We set out to document the occurrence of kidney disease in HIV-positive Africans on TDF-containing ART in population-based studies and to evaluate the renal safety of TDF in Africans. Methods We conducted a systemic review using published studies which were identified through a computerized search of original research using the Medline/PubMed database, EMBASE, EBM Reviews, Proquest Google Scholar and Global Health reported from inception until 5 October 2017. Two reviewers independently abstracted the data and performed quality assessment of the included studies. We screened 595 articles and included 31 in the qualitative analysis performed. Results A total of 106 406 patients (of whom 66,681 were on Tenofovir) were involved in these 31 studies with sample sizes ranging from 30 to 62,230. Duration on tenofovir-containing ART ranged from those initiating ART at baseline to those who received TDF for up to 9 years. All but one of the studies involved only patients 16 years and older. The studies had differing definitions of kidney dysfunction and were of variable study design quality. The documented outcomes had substantial discrepancies across the studies, most likely due to methodological differences, study size and disparate outcome definitions. Conclusions Our review identified studies in Africans reporting statistically significant renal function decline associated with TDF use but the clinical significance of this effect was not enough to contraindicate its continued use in ART regimens. Consistent with studies in other populations, patients are at greater risk if they have pre-existing renal disease and are more advanced in age. More research is needed on paediatric populations under 16 years of age. Trial registration This review was registered on Prospero (registration number CRD42018078717). Electronic supplementary material The online version of this article (10.1186/s12981-019-0227-1) contains supplementary material, which is available to authorized users.

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“…There is no study in Africa as well as in Ethiopia to show the extent of fall in eGFR greater than 25% relative to baseline. However, a prospective case cohort study in South Africa showed that among admitted patients with AKI 61% were on TDF based antiretroviral regimen [21].…”

Section: Introductionmentioning

confidence: 99%

Reduced Kidney Function in Tenofovir Disoproxil Fumarate Based Regimen and Associated Factors: A Hospital Based Prospective Observational Study in Ethiopian Patients

Yazie

Orjino

Degu

2019

International Journal of Nephrology

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Purpose. Tenofovir disoproxil fumarate (TDF), a drug broadly used in combination antiretroviral therapy, is associated with renal dysfunction but the prevalence varied from country to country and it is not known in Ethiopia. The objectives of this study were to assess the prevalence of renal dysfunction and risk factors associated with it and the mean change in estimated glomerular filtration rate in human immunodeficiency virus infected patients receiving TDF based antiretroviral regimen at Tikur Anbessa Specialized Hospital. Method. It was a hospital based prospective cohort study. The study participants were treatment naïve HIV infected patients initiating TDF containing combination antiretroviral therapy or switched to it because of adverse events. Multivariable logistic analysis was used to identify variables which have significant association. Result. A total of 63 study participants were studied, 16 (25.4%) of whom had fall in eGFR greater than 25% relative to baseline. Only age greater than 50 years, baseline CD4 count less than 200 cells/mm3, and baseline proteinuria were significantly associated with renal dysfunction in multivariable logistic regression. There was -8.4 ml/min/1.73m2 mean change in estimated glomerular filtration rate relative to baseline at six months of study. Conclusion. The renal dysfunction (defined as decline in eGFR greater than 25%) was found in a quarter of the study population. The long term impact and the clinical implication of it are not clear. Future prospective study is required with large sample size and long duration to ascertain the prevalence of decline greater than 25% in estimated glomerular filtration rate and its progression to chronic kidney disease.

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Acute Kidney Injury, Risk Factors, and Prognosis in Hospitalized HIV-Infected Adults in South Africa, Compared by Tenofovir Exposure

Cited by 17 publications

References 37 publications

Approach to acute kidney injury in HIV-infected patients in South Africa

Approach to acute kidney injury in HIV-infected patients in South Africa

Tenofovir-associated kidney disease in Africans: a systematic review

Reduced Kidney Function in Tenofovir Disoproxil Fumarate Based Regimen and Associated Factors: A Hospital Based Prospective Observational Study in Ethiopian Patients

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