Amprenavir and didanosine are associated with declining kidney function among patients receiving tenofovir.
OBJECTIVE
To examine the effect of antiretroviral agents and clinical factors on the development of tenofovir-associated kidney dysfunction.


METHODS
Observational cohort study of HIV-infected patients receiving tenofovir in an HIV clinic population. Patients' kidney function prior to initiating and while receiving tenofovir was evaluated in relation to other antiretroviral medications and demographic and clinical characteristics. Decline in kidney function was assessed by the glomerular filtration rate (GFR) as estimated by the Cockcroft-Gault (CG) equation, which incorporates weight. Logistic regression analysis was used to examine factors associated with GFR of > 90, 60-90, 30-60, and < 30 ml/min per 1.73 m(2) while on tenofovir. Secondary analyses used the simplified Modification of Diet in Renal Disease (MDRD) equation.


RESULTS
Among the 445 patients initiating tenofovir, 51 (11%) developed a decline in kidney function. In multivariate analysis, there was a significant association between decline in kidney function and concurrent use of amprenavir [odds ratio (OR) 3.6; P = 0.045] and didanosine (OR, 3.1; P = 0.006), age over 50 years (OR, 4.4; P = 0.03), and lower baseline weight (OR, 0.95/kg; P < 0.001). Patients identified with kidney dysfunction by the MDRD equation did not fully overlap with those identified by the CG equation.


CONCLUSIONS
Didanosine and amprenavir use, increased age, and lower baseline weight were significantly associated with risk for kidney dysfunction among patients receiving tenofovir. GFR results using the MDRD equation were inconsistent with those using CG, which highlights the impact of including weight in the estimation of GFR among HIV-infected patients.
Crane
Heidi M
HM
Department of Medicine, University of Washington, Seattle, Washington 98104, USA. hcrane@u.washington.edu
Kestenbaum
Bryan
B
Harrington
Robert D
RD
Kitahata
Mari M
MM
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001835:Body Weight; D002219:Carbamates / Q000009:adverse effects / Q000627:therapeutic use; D003404:Creatinine / Q000652:urine; D016049:Didanosine / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D005663:Furans; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism; D015497:HIV-1; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use; D000068698:Tenofovir; D013997:Time Factors
D019380:Anti-HIV Agents; D002219:Carbamates; D005663:Furans; D063065:Organophosphonates; D013449:Sulfonamides; C095108:amprenavir; D000068698:Tenofovir; D003404:Creatinine; D000225:Adenine; D016049:Didanosine