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

Abstract

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.

Determinants of Risk Factors for Renal Impairment among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Antiretroviral Regimen in Southern Vietnam

“…Compared with patients aged 20-29 years, patients with ages equal to and greater than 60 years were more likely to report renal impairment. is finding was in agreement with studies conducted in Ethiopia [25] and Malaysia [10], which showed that old age was considered to be a risk factor for TDF induced nephrotoxicity. It is known that kidney function and structure would deteriorate by age [25,32].…”

“…In the current study, we also found that patients who had low BMI were significantly associated with renal impairment compared with those who had normal BMI; this result was similar to studies conducted in Vietnam and Japan [9,28,29], but in contrast to the study conducted in Ethiopia [25]. It may be different sample sizes [25], duration of study time, as a little is known about BMI effect on renal function on the long term [9]; therefore, the need for deep and longterm research should be taken into account.…”

“…In the current study, we also found that patients who had low BMI were significantly associated with renal impairment compared with those who had normal BMI; this result was similar to studies conducted in Vietnam and Japan [9,28,29], but in contrast to the study conducted in Ethiopia [25]. It may be different sample sizes [25], duration of study time, as a little is known about BMI effect on renal function on the long term [9]; therefore, the need for deep and longterm research should be taken into account. As shown in our study, we did not find the relationship between cotrimoxazole, hepatitis B, C virus infection, and renal impairment which was consistent with the study conducted in Vietnam [9]; however, these predictors could be affected by renal impairment [30,31].…”

“…is could be explained that differences in genetic factors correlated with an inherited polymorphism in drug transporter proteins of the renal tubule which led to TDF accumulation in the proximal tubular cells [24,25], and several studies also showed that HIV affected direct renal pathogenic role [13,26,27].…”

“…In this study, we used the Kidney Disease Outcomes Quality Initiative (KDOQI) of the National Kidney Foundation to clarify the eGFR (ml/min/1.73 m 2 ) group including 6 stages (stage 1 (>90), stage 2 (60-89), stage 3a (45-59), stage 3b (30-44), stage 4 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and stage 5 (<15)).…”