Tenofovir‐induced acute kidney injury in HIV‐infected patients in western India: a resource limited setting perspective

Abstract

Background and objectiveTenofovir use in HIV positive patients is associated with 0.5–2.5% risk of acute kidney injury (AKI). Data on AKI due to tenofovir use in resource limited settings like India is sparse. Objective of this study is to determine incidence, risk factors and outcome of tenofovir‐induced acute kidney injury (serum creatinine>2 mg/dl or creatinine clearance decrease by 50% compared to baseline) in HIV infected patients attending tertiary level HIV clinic in Western India.MethodsAll patients enrolled at the clinic from 2009 to 2012 who were initiated on tenofovir‐based ART and had regular follow up creatinine clearance values available were included in this retrospective observational cohort analysis. Patients already on tenofovir‐based ART during enrollment were also included.Summary of results512 patients were enrolled in the study with 70% being males. Average age of the cohort was 41 years, average body weight 56 kilograms and median baseline CD4 count 164 cells/mm3. Mean baseline creatinine clearance was 90 ml/min. Median duration of follow up was 26 months. Tenofovir‐induced AKI developed in 25 patients (incidence 4.88 %). Median time to developing AKI was 6 months. On stopping tenofovir, 15 patients had complete recovery of renal function, 5 had partial recovery while 5 patients died. Hemodialysis as a treatment option was used in 3 patients. Age>50 yrs (p=0.001), baseline creatinine clearance<50 ml/min (p=0.0001), diabetes mellitus (p=0.0001), use of tenofovir with protease inhibitors (p=0.001), presence of renal calculus disease (p =0.0001) and use of concomitant nephrotoxic medications (p=0.001) were significantly associated with risk of tenofovir AKI on applying Pearson's Chi square test.ConclusionsIncidence of tenofovir‐induced AKI in our cohort is higher than previously reported and could be attributed to lower body weight, lower baseline creatinine clearance, higher incidence of advanced HIV disease and higher incidence of co‐morbidities in our patients.