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Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Research Article

Determinants and Incidence of Chronic Kidney Disease with Tenofovir- Based Antiretroviral Therapy Regimens: A Cohort Study in HIV-Infected Adults in South China

Author(s): Fang Liu*, Yi Wang, Hong Liu, Chen Chen, Liang-Bin Miao, Zhao-Yi Li, Miao-Chan Wang, Jin-Song Huang* and Jian-Feng Bao*

Volume 20, Issue 3, 2022

Published on: 30 June, 2022

Page: [242 - 250] Pages: 9

DOI: 10.2174/1570162X20666220428105300

Price: $65

Abstract

Background: The data of the impact of tenofovir (TDF) on kidney damage in Chinese HIV-1 infected patients are limited.

Objective: The study aims to evaluate the incidence and risk factors of stage 3 chronic kidney disease (CKD) and rapid kidney function decline (RKFD) among Chinese HIV-1 infected patients starting with a TDF-based regimen.

Methods: We enrolled 797 TDF-initiated HIV-1-infected patients in a Chinese cohort. Kidney dysfunctions were defined as stage 3 CKD (eGFR < 60 mL/min/1.73 m2 during follow-up) and RKFD (eGFR decline > 10 mL/min/1.73 m2/year). A linear mixed-effects model was used to quantify the average eGFR change per 48 weeks. A generalized estimating equation regression analysis was conducted to determine the risk factors associated with renal dysfunction. The method of multiple imputations was used to reduce the bias caused by missing data.

Results: In this retrospective study, 14 (2%) patients experienced stage 3 CKD, and 272 (34%) individuals experienced RKFD during a median of 26 (IQR, 4-78; maximum 325) weeks follow-up period. The mean loss in eGFR per 48 weeks increased consistently over time, from -2.59 mL/min/1.73 m2 before 48 weeks to -17.61 mL/min/1.73 m2 after 288 weeks. For every 10 mL/min/1.73 m2 increase of eGFR, the risk of RKFD increased by 29% (95%CI: 18%, 40%). Each 10 years older and every 10 mL/min/1.73 m2 higher in baseline eGFR, the risk of stage 3 CKD increased to 1.56 (95% CI: 1.00, 2.43) and decreased by 65% (95% CI: 48%, 76%), respectively. Anemia and higher viral load were significantly associated with RKFD. The results were robust across a range of multiple imputation analyses.

Conclusion: TDF-associated CKD is rare in HIV-1 infected Chinese adults. Longer TDF-exposed patients are more likely to have renal dysfunction, especially those with older age, anemia, lower baseline eGFR, and higher viral load.

Keywords: HIV, antiviral therapy, chronic kidney disease, tenofovir, renal dysfunction, rapid kidney function decline.

Graphical Abstract
[1]
Nsanzimana S, Remera E, Kanters S, et al. Life expectancy among HIV-positive patients in Rwanda: A retrospective observational cohort study. Lancet Glob Health 2015; 3(3): e169-77.
[http://dx.doi.org/10.1016/S2214-109X(14)70364-X] [PMID: 25701995]
[2]
Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: A modelling study. Lancet Infect Dis 2015; 15(7): 810-8.
[http://dx.doi.org/10.1016/S1473-3099(15)00056-0] [PMID: 26070969]
[3]
Brennan A, Evans D, Maskew M, et al. Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir. AIDS 2011; 25(13): 1603-9.
[http://dx.doi.org/10.1097/QAD.0b013e32834957da] [PMID: 21646902]
[4]
Choi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Volberding PA, O’Hare AM. The impact of HIV on chronic kidney disease outcomes. Kidney Int 2007; 72(11): 1380-7.
[http://dx.doi.org/10.1038/sj.ki.5002541] [PMID: 17805235]
[5]
Kalayjian RC, Lau B, Mechekano RN, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiat-ing antiretroviral therapy in routine care. AIDS 2012; 26(15): 1907-15.
[http://dx.doi.org/10.1097/QAD.0b013e328357f5ed] [PMID: 22824630]
[6]
Suzuki S, Nishijima T, Kawasaki Y, et al. Effect of tenofovir disoproxil fumarate on incidence of chronic kidney disease and rate of esti-mated glomerular filtration rate decrement in HIV-1-infected treatment-naïve asian patients: Results from 12-year observational cohort. AIDS Patient Care STDS 2017; 31(3): 105-12.
[http://dx.doi.org/10.1089/apc.2016.0286] [PMID: 28282247]
[7]
Cihlar T, Ho ES, Lin DC, Mulato AS. Human renal organic anion transporter 1 (hOAT1) and its role in the nephrotoxicity of antiviral nucleotide analogs. Nucleosides Nucleotides Nucleic Acids 2001; 20(4-7): 641-8.
[http://dx.doi.org/10.1081/NCN-100002341] [PMID: 11563082]
[8]
Scherzer R, Estrella M, Li Y, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS 2012; 26(7): 867-75.
[http://dx.doi.org/10.1097/QAD.0b013e328351f68f] [PMID: 22313955]
[9]
Mizushima D, Tanuma J, Kanaya F, et al. WHO antiretroviral therapy guidelines 2010 and impact of tenofovir on chronic kidney disease in Vietnamese HIV-infected patients. PLoS One 2013; 8(11): e79885.
[http://dx.doi.org/10.1371/journal.pone.0079885] [PMID: 24223203]
[10]
Nishijima T, Kawasaki Y, Tanaka N, et al. Long-term exposure to tenofovir continuously decrease renal function in HIV-1-infected pa-tients with low body weight: Results from 10 years of follow-up. AIDS 2014; 28(13): 1903-10.
[http://dx.doi.org/10.1097/QAD.0000000000000347] [PMID: 25259702]
[11]
Tan Q, He Y-H, Yang T-T, et al. Effects of long-term exposure to tenofovir disoproxil fumarate-containing antiretroviral therapy on renal function in HIV-positive Chinese patients. Journal of microbiology, immunology, and infection - Wei mian yu gan ran za zhi 2019; 52(5): 710-9.
[12]
Liu X, Qiu X, Shi C, et al. Modified glomerular filtration rate-estimating equations developed in asiatic population for chinese patients with type 2 diabetes. Int J Endocrinol 2014; 2014: 521071.
[http://dx.doi.org/10.1155/2014/521071] [PMID: 24734043]
[13]
Chang H, Ye SD. Application of modified glomerular filtration rate estimation equations in chinese diabetic patients with chronic kidney diseases. West Indian Med J 2015; 64(3): 209-12.
[PMID: 26426171]
[14]
Erviti J, Alonso A, Oliva B, et al. Oral bisphosphonates are associated with increased risk of subtrochanteric and diaphyseal fractures in elderly women: A nested case-control study. BMJ Open 2013; 3(1): e002091.
[http://dx.doi.org/10.1136/bmjopen-2012-002091] [PMID: 23370011]
[15]
White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 2011; 30(4): 377-99.
[http://dx.doi.org/10.1002/sim.4067] [PMID: 21225900]
[16]
Ichikawa M, Hosono A, Tamai Y, et al. Handling missing data in an FFQ: Multiple imputation and nutrient intake estimates. Public Health Nutr 2019; 22(8): 1351-60.
[http://dx.doi.org/10.1017/S1368980019000168] [PMID: 30803461]
[17]
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): Expla-nation and elaboration. Int J Surg 2014; 12(12): 1500-24.
[http://dx.doi.org/10.1016/j.ijsu.2014.07.014] [PMID: 25046751]
[18]
Msango L, Downs JA, Kalluvya SE, et al. Renal dysfunction among HIV-infected patients starting antiretroviral therapy. AIDS 2011; 25(11): 1421-5.
[http://dx.doi.org/10.1097/QAD.0b013e328348a4b1] [PMID: 21572304]
[19]
Bygrave H, Kranzer K, Hilderbrand K, et al. Renal safety of a tenofovir-containing first line regimen: Experience from an antiretroviral cohort in rural Lesotho. PLoS One 2011; 6(3): e17609.
[http://dx.doi.org/10.1371/journal.pone.0017609] [PMID: 21407815]
[20]
Zachor H, Machekano R, Estrella MM, et al. Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens. AIDS 2016; 30(8): 1221-8.
[http://dx.doi.org/10.1097/QAD.0000000000001041] [PMID: 26836786]
[21]
Ding Y, Duan S, Ye R, et al. Effects of aging, baseline renal function and stage of HIV infection on post-treatment changes in renal func-tion among HIV-infected patients: A retrospective cohort study. HIV Med 2019; 20(9): 591-600.
[http://dx.doi.org/10.1111/hiv.12763] [PMID: 31274235]
[22]
Kimaro FD, Jumanne S, Sindato EM, Kayange N, Chami N. Prevalence and factors associated with renal dysfunction among children with sickle cell disease attending the sickle cell disease clinic at a tertiary hospital in Northwestern Tanzania. PLoS One 2019; 14(6): e0218024.
[http://dx.doi.org/10.1371/journal.pone.0218024] [PMID: 31211789]
[23]
Yilma D, Abdissa A, Kæstel P, et al. Renal function in Ethiopian HIV-positive adults on antiretroviral treatment with and without tenofo-vir. BMC Infect Dis 2020; 20(1): 582.
[http://dx.doi.org/10.1186/s12879-020-05308-9] [PMID: 32762646]
[24]
Mocroft A, Lundgren JD, Ross M, et al. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: A prospective international cohort study. Lancet HIV 2016; 3(1): e23-32.
[http://dx.doi.org/10.1016/S2352-3018(15)00211-8] [PMID: 26762990]

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