Predictors of AKI During TDF Treatment Identified

Hepatitis C viremia and HIV viremia were the greatest predictors of acute kidney injury (AKI) during treatment with tenofovir disoproxil fumarate (TDF), according to the results of a recent study.

While previous studies have identified risk factors for renal dysfunction in male veterans and populations in Asia undergoing treatment with TDF, whether or not these results generalize to female patients and other ethnic groups is unknown.

To explore this relationship further, the researchers conducted a retrospective review of HIV infected patients treated with TDF who began TDF between January 1, 2012 and December 31, 2016. Demographic and clinical data were collected from the Electronic Medical Record. AKI was defined as a 50% or greater rise in serum creatinine following TDF initiation.

The 660 participants were mostly male (79.8%) and ethnically white (69.7%), African-American (22.6%), and Hispanic (6.8%). Overall, 88 participants developed AKI during the study period.

In Kaplan-Meier analyses, the risk of AKI was greater in women, upper tertile of age (47.5 years or older), and among patients with hypertension, diabetes mellitus, and those having detectable HIV viremia or Hepatitis C viremia.

In the Cox Proportional Hazards analyses, female sex (hazard ratio [HR] 1.68), upper tertile of age (HR 1.94), HTN (HR 1.70), unsuppressed HIV viral load (HR 2.75), and Hepatitis C viremia (HR 2.65) were associated with an increased risk of AKI. Ethnicity and diabetes mellitus were not associated with risk of AKI.

“The factors associated with greatest AKI risk during TDF treatment were hepatitis C viremia and HIV viremia. Older age, female sex, and hypertension were significantly associated with increased AKI. We found neither DM nor ethnicity were independently associated with AKI.”

—Michael Potts

Reference:

Clinical Predictors of Acute kidney injury in HIV infected patients treated with tenofovir disoproxil fumarate (TDF) [presented at IDWeek 2018]. San Francisco, California. October 6, 2018.