title: Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients.
abstract: BACKGROUND
  Treatment with tenofovir is sometimes associated with renal dysfunction. Limited information is available on this side effect in patients with small body weight, although the use of tenofovir will spread rapidly in Asia and Africa, where patients are likely to be of smaller body weight.
  
  
  METHODS
  In a single-center cohort, Japanese patients with HIV infection who started tenofovir-containing antiretroviral therapy were retrospectively analyzed. The incidence of tenofovir-associated renal dysfunction, defined as more than 25% decrement of estimated glomerular filtration rate (eGFR) from the baseline, was determined. The effects of small body weight and body mass index (BMI) on tenofovir-associated renal dysfunction, respectively, were estimated in univariate and multivariate Cox hazards models as the primary exposure. Other possible risk factors were evaluated by univariate analysis and those found significant were entered into the multivariate analysis.
  
  
  RESULTS
  The median weight of 495 patients was 63 kg. Tenofovir-related renal dysfunction occurred in 97 (19.6%) patients (incidence: 10.5 per 100 person-years). Univariate analysis showed that the incidence of tenofovir-related renal dysfunction was significantly associated with smaller body weight and BMI, respectively (per 5 kg decrement, HR = 1.23; 95% CI, 1.10-1.37; p<0.001)(per 1 kg/m(2) decrement, HR = 1.14; 95% CI, 1.05-1.23; p = 0.001). Old age, high baseline eGFR, low serum creatinine, low CD4 count, high HIV viral load, concurrent nephrotoxic drugs, hepatitis C infection, and current smoking were also associated with tenofovir-related renal dysfunction. Multivariate analysis identified small body weight as a significant risk (adjusted HR = 1.13; 95% CI, 1.01-1.27; p = 0.039), while small BMI had marginal significance (adjusted HR = 1.07; 95% CI 1.00-1.16; p = 0.058).
  
  
  CONCLUSIONS
  The incidence of tenofovir-associated renal dysfunction in Japanese patients was high. Small body weight was identified as an independent risk factor for tenofovir-associated renal dysfunction. Close monitoring of renal function is advocated for patients with small body weight treated with tenofovir.
authors.affiliation: National Center for Global Health and Medicine, Tokyo, Japan. tnishiji@acc.ncgm.go.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishijima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Gatanaga
authors.forename: Takahiro
authors.initials: T
authors.lastname: Aoki
authors.forename: Koji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Ei
authors.initials: E
authors.lastname: Kinai
authors.forename: Haruhito
authors.initials: H
authors.lastname: Honda
authors.forename: Junko
authors.initials: J
authors.lastname: Tanuma
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yazaki
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Tsukada
authors.forename: Miwako
authors.initials: M
authors.lastname: Honda
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D044466:Asian People; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine