Abstract
Background. Prospective studies about the reversibility of tenofovir disoproxil fumarate- (TDF-) related renal impairment remain scarce. Methods. This is an observational prospective study including all patients that presented at our HIV Unit who interrupted TDF owing to nephrotoxicity. We assessed the evolution of renal parameters after discontinuation of this drug. Results. We included 59 patients, who were followed up for 72 weeks. Most were male (41, 69.5%), median (IQR) age was 53 (44; 58) years, and median time receiving TDF-containing regimens was 55.4 (28; 87.7) months. Most patients were receiving PI-based treatments (67%). At the final visit, most of the subjects showed complete recovery (35, 59.3%) or improvement (13 subjects, 22%). Significant improvements were observed in creatinine levels (from 84.9 [73.8; 97.5] to 78 [69.6; 91] μmol/L, p = 0.013), estimated glomerular filtration rate (eGFR, CKD EPI equation, from 87.7 [67; 99] to 89.9 [73.6; 99.3] mL/min/1.73 m2, p = 0.017), and number of patients with eGFR <60 mL/min/1.73 m2 (from 9 [15.3%] to 1 [1.7%], p = 0.031). A trend toward significance was observed in abnormal urine proteinuria/creatinine ratio (from 22 [37%] to 8 [13.6%], p = 0.057). Conclusions. Our results corroborate the high frequency of complete or partial renal recovery in patients receiving TDF-containing regimens who discontinued therapy owing to nephrotoxicity.
Highlights
Nephrotoxicity associated with tenofovir disoproxil fumarate (TDF) has been well characterized in clinical and study cohorts [1, 2], prospective studies assessing TDFrelated renal toxicity in clinical practice are scarce
The most frequent renal abnormality before discontinuation of TDF was altered proteinuria/creatinine ratio (37%), which was mild in most cases (69.5%); 5 patients (6.7%) presented occasional proteinuria >1 g, and only 2 patients (3%) had sustained proteinuria >1 g
Time to the event with data from retrospective [3, 4] and cross-sectional studies [6], our findings show that proteinuria is the most common tenofovir disoproxil fumarate- (TDF-)related renal abnormality
Summary
Nephrotoxicity associated with tenofovir disoproxil fumarate (TDF) has been well characterized in clinical and study cohorts [1, 2], prospective studies assessing TDFrelated renal toxicity in clinical practice are scarce. Discontinuation of TDF does not lead to complete reversibility of renal damage [3, 4]. The principal aim of this prospective study was to assess changes in laboratory values in a cohort of patients who interrupted TDF owing to nephrotoxicity. Prospective studies about the reversibility of tenofovir disoproxil fumarate- (TDF-) related renal impairment remain scarce. This is an observational prospective study including all patients that presented at our HIV Unit who interrupted TDF owing to nephrotoxicity. Our results corroborate the high frequency of complete or partial renal recovery in patients receiving TDF-containing regimens who discontinued therapy owing to nephrotoxicity
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