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The objective of this study was to evaluate the risk factors for progression to chronic kidney disease (CKD) after tenofovir disoproxil fumarate (TDF)-induced acute kidney injury (AKI).
This was a retrospective cohort of adult patients treated with highly active antiretroviral therapy (HAART) and followed at a referral center for HIV care. We included patients in whom the TDF element of the HAART was discontinued because of the development of AKI between January 2016 and December 2018. After the AKI event, the patients were followed for at least 12 months or until recovery of renal function (RF). Univariate and multivariate analyses of risk factors were performed (with a significance level set at p < 0.05).
Of the 128 patients included, 90 (70.3%) had at least one comorbidity. The median time on HAART and on HAART with TDF was 66.5 months and 32.5 months, respectively. In the univariate analysis, baseline (at HIV diagnosis) viral load (VL) > 500,000 copies/ml, glomerular filtration rate (GFR) < 60 ml/min/1.73 m², and GFR < 90 ml/min/1.73 m² showed ORs for non-recovery of RF of 4.57 (95% CI: 1.71-12.23, p = 0.003), 2.97 (95% CI: 1.10-7.97, p = 0.04), and 0.11 (95% CI: 0.05-0.28, p < 0.01), respectively. A two-component analysis of the major clinical characteristics related to non-recovery of RF (Age ≥ 60 years, GFR < 60 ml/min/1,73 m², male gender, VL > 500,000 copies/ml, Data Collection on Adverse Events of Anti-HIV Drugs score > 5%, and self-reported drug addiction) revealed 94% variance. The median GFR at diagnosis was 98 ml/min/1.73 m²; in the patients who had been on HAART with TDF, there was a median loss of 20 ml/min/1.73 m² after AKI.
Our findings indicate that the use of TDF is a risk factor for AKI-induced CKD, even after its withdrawal. A high VL and a GFR < 60 ml/min/1.73 m² (i.e., CKD) at HIV diagnosis seem to be risk factors for non-recovery of RF after TDF withdrawal, whereas a GFR > 90 ml/min/1.73 m² at HIV diagnosis is apparently protective against that outcome.