title: The significance of antiretroviral-associated acute kidney injury in a cohort of ambulatory human immunodeficiency virus-infected patients.
abstract: BACKGROUND
  To determine the incidence and significance of acute kidney injury (AKI) after initiating highly active antiretroviral therapy (HAART).
  
  
  METHODS
  A prospective cohort study of 271 consecutively treated HIV-infected patients, initiating first (75) or sequential HAART (196) from January 2008 to June 2011. AKI was diagnosed according to the Risk, Injury, Failure, Loss of kidney function, End-stage renal disease (RIFLE)/Acute Kidney Injury Network (AKIN) criteria, and the risk of progression to chronic kidney disease (CKD) was evaluated.
  
  
  RESULTS
  A greater estimated glomerular filtration rate (eGFR) decrease after 1 year was observed for patients initiating a tenofovir disoproxil fumarate (TDF)-based regimen (-6.45 versus +0.98 mL/min/1.73 m(2) when compared with patients without TDF; P < 0.01), both in the case of the first (-8.5 versus -2.27; P = 0.04) or successive regimens (-5.3 versus + 1.18 mL/min/1.73 m(2); P < 0.01). AKI, as defined, was observed in 10% (28 cases, 6.98 episodes/100 patients-year), mostly stage I (27 cases), in a median time of 6 (3-16.5) months. Four cases (14%), having a worse baseline renal function progressed to CKD, whereas four recovered completely. In the multivariate analysis, AKI was associated with the concomitant use of cotrimoxazole prophylaxis and to low CD4+ count. CKD was diagnosed in 2% (six cases) of patients. Therefore, the overall rate of HAART-associated renal disorders was 11% (30 cases, 7.46 episodes/100 patients-year (95% confidence interval, 6.09-8.83).
  
  
  CONCLUSIONS
  The initiation of a tenofovir-based regimen is followed by a significant decline in eGFR, although it could be misinterpreted by the concomitant use of cotrimoxazole. A substantial proportion of patients develop AKI, but only a minority progress to CKD. Patients initiating HAART and developing AKI should be carefully monitored for progression of renal disease.
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: Philip
authors.initials: P
authors.lastname: Wikman
authors.forename: Pablo
authors.initials: P
authors.lastname: Safont
authors.forename: María
authors.initials: M
authors.lastname: Del Palacio
authors.forename: Ana
authors.initials: A
authors.lastname: Moreno
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.forename: José L
authors.initials: JL
authors.lastname: Casado
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000821:virology; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D063065:Organophosphonates / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine
keywords: AKI; antiretroviral; cotrimoxazole nephrotoxicity; outcome; tenofovir