Evolution of glomerular filtration rate in HIV-infected, HIV-HBV-coinfected and HBV-infected patients receiving tenofovir disoproxil fumarate

2013 ◽  
Vol 20 (9) ◽  
pp. 650-657 ◽  
Author(s):  
P. Pradat ◽  
M.-A. Le Pogam ◽  
J.-B. Okon ◽  
P. Trolliet ◽  
P. Miailhes ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Tenofovir Disoproxil Fumarate ◽  
Filtration Rate

scholarly journals An overview of tenofovir and renal disease for the HIV-treating clinician

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Willem D.F. Venter ◽  
June Fabian ◽  
Charles Feldman
Keyword(s):  
Risk Factors ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Hepatitis B ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Tenofovir Disoproxil Fumarate ◽  
Filtration Rate ◽  
Tubular Function

Tenofovir disoproxil fumarate (TDF, commonly termed ‘tenofovir’) is the antiretroviral most commonly implicated in antiretroviral-induced nephrotoxicity. As patients on successful antiretroviral therapy (ART) age, their risk for developing renal disease may increase in part because of ART itself, but more importantly, because of HIV-associated and non-HIV-associated comorbidity. Therefore, clinicians need an approach to managing renal disease in people on TDF. TDF as a cause of acute kidney injury (AKI) or chronic kidney disease (CKD) is uncommon, and clinicians should actively exclude other causes (Box 1). In TDF-associated AKI, TDF should be interrupted in all cases, and replaced, or ART interrupted altogether. Tenofovir disoproxil fumarate toxicity can present as AKI or CKD, and as a full or partial Fanconi’s syndrome. TDF has a small but definite negative impact on kidney function (up to a 10% decrease in glomerular filtration rate [GFR]). This occurs because of altered tubular function in those exposed to TDF for treatment and as pre-exposure prophylaxis. Renal function should be assessed using creatinine-based estimated GFR at the time of initiation of TDF, if ART is changed, at 1–3 months, and then ideally every 6–12 months if stable. Specific tests of tubular function are not routinely recommended; in the case of clinical concern, a spot protein or albumin: creatinine ratio is preferable, but in resource-limited settings, urine dipstick can be used. More frequent monitoring may be required in those with established CKD (estimated glomerular filtration rate [eGFR] < 50 mL/min/1.73 m2) or risk factors for kidney disease. The most common risk factors are comorbid hypertension, diabetes, HIV-associated kidney disease, hepatitis B or C co-infection, and TDF in combination with a ritonavir-boosted protease inhibitor. Management of these comorbid conditions must be prioritised in this group. If baseline screening eGFR is < 50 mL/min/1.73 m2, abacavir (the preferred option), and dose-adjusted TDF (useful if concomitant hepatitis B), zidovudine or stavudine (d4T) remain alternatives to full-dose TDF. If there is a rapid decline in kidney function (eGFR drops by more than 25% and decreases to < 50 mL/min/1.73 m2 from of baseline function), or there is new onset or worsening of proteinuria or albuminuria, clinicians should review ART and other potentially nephrotoxic medications and comorbidity and conduct further testing if indicated. If kidney function does not improve after addressing reversible causes of renal failure, then referral to a nephrologist is appropriate. In the case of severe CKD, timeous referral for planning for renal replacement therapy is recommended. Tenofovir alafenamide, a prodrug of tenofovir, appears to have less renal toxicity and is likely to replace TDF in future.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Taklo Simeneh Yazie ◽  
Teferra Abula Orjino ◽  
Wondwossen Amogne Degu
Keyword(s):  
Glomerular Filtration Rate ◽  
Antiretroviral Therapy ◽  
Renal Dysfunction ◽  
Glomerular Filtration ◽  
Tenofovir Disoproxil Fumarate ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Large Sample Size ◽  
Combination Antiretroviral Therapy ◽  
Study Participants

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.

scholarly journals KHẢO SÁT TÁC ĐỘNG CỦA TENOFOVIR DISOPROXIL FUMARATE LÊN CHỨC NĂNG THẬN Ở BỆNH NHÂN VIÊM GAN VI RÚT B MẠN

2021 ◽  
Vol 498 (1) ◽  
Author(s):  
Võ Duy Thông ◽  
Võ Ngọc Diễm
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Tenofovir Disoproxil Fumarate ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate

Mục tiêu: Khảo sát tác động của tenofovir disoproxil fumarate (TDF) lên chức năng thận ở bệnh nhân viêm gan vi rút B mạn. Đối tượng và phương pháp: Nghiên cứu cắt ngang mô tả tiến hành trên 60 bệnh nhân viêm gan B mạn điều trị ngoại trú với TDF tại Bệnh viện Đại Học Y Dược TP HCM từ tháng 05/2017 đến tháng 10/2020. Kết quả: Tuổi trung bình trong nghiên cứu là 42,10 ± 13,30; Tỷ lệ nam giới 39/60 (65,0%). Mức creatinine trung bình đã tăng đáng kể ở tuần thứ 24 và 48 (p < 0,01). Tương tự, độ lọc cầu thận ước tính (estimated Glomerular Filtration Rate – eGFR) giảm có ý nghĩa ở tuần thứ 24 và 48 (p < 0,05). Kết luận: Kết quả nghiên cứu cho thấy chức năng thận giảm so với ban đầu ở bệnh nhân viêm gan vi rút B mạn điều trị TDF, cho thấy chức năng thận cần được theo dõi thường xuyên ở những bệnh nhân đang điều trị với TDF.

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