#4815 COMPARISON OF DIFFERENT ANTIVIRALS REGARDING THEIR ASSOCIATION WITH HOSPITAL-ACQUIRED ACUTE KIDNEY INJURY AMONG ADULTS WITH HERPES ZOSTER

Abstract

Abstract Background and Aims Antiviral therapy is commonly used to treat herpes zoster. Though antivirals are generally considered nephrotoxic, few studies compared the relative risk of acute kidney injury in patients with herpes zoster that is attributable to different antivirals. We aim to examine the association of use of different antivirals with hospital-acquired acute kidney injury (HA-AKI) among Chinese adults with herpes zoster. Method The study population was derived from the China Renal disease System (CRDS), a retrospective cohort of hospitalized patients from 19 medical centers throughout China. We selected from CRDS 3,847 adults who received antiviral therapy for herpes zoster during hospitalization. We identify and stage AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared the relative risks of HA-AKI among patients treated with different antivirals using Cox proportional hazards model, and explored the non-linear association between the accumulative dose of antivirals and the risk of HA-AKI using a penalized smoothing spline. Results Among 3,847 patients, 1,585 (41.2%), 699 (18.2%), 599 (15.6%) and 964 (25.1%) were treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. The incidence of HA-AKI was 4.9%, 2.9%, 2.8% and 0.8%, respectively, in the patients treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet. Compared with acyclovir/valacyclovir therapy, use of foscarnet was associated with a 69% reduction in the risk of HA-AKI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.14-0.66), while use of other nucleoside analogues was associated with a marginally lower risk of HA-AKI, with a HR (95% CI) of 0.62 (0.36-1.09) for penciclovir/famciclovir and 0.67 (0.41-1.11) for ganciclovir. When compared with foscarnet, nucleoside analogues (HR, 2.72; 95% CI, 1.28-5.75) showed a higher risk of HA-AKI. The associations were consistent across various subgroups and sensitivity analysis. Conclusion Among antiviral therapies for herpes zoster, acyclovir/valacyclovir was associated with the highest relative risk of HA-AKI, and the association appears to be dose dependent. Clinicians should exercise rational drug use according to the different renal toxicity associated with a particular antiviral drug.