Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients.
Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients.
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DOI：
10.1371/journal.pone.0022661
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Oka S
中科院分区：
文献类型：
--
作者：
Nishijima T;Komatsu H;Gatanaga H;Aoki T;Watanabe K;Kinai E;Honda H;Tanuma J;Yazaki H;Tsukada K;Honda M;Teruya K;Kikuchi Y;Oka S
替诺福韦的治疗有时与肾功能障碍有关。尽管替诺福韦的使用将在亚洲和非洲迅速传播，但关于体重较小患者的这种副作用的信息有限，这些地区的患者可能体重较轻。在一项单中心队列研究中，对接受替诺福韦抗逆转录病毒治疗的日本HIV感染者进行了回顾性分析。确定替诺福韦相关性肾功能障碍的发生率，定义为估计肾小球滤过率(EGFR)较基线下降超过25%。小体重和体重指数(BMI)对替诺福韦相关肾功能障碍的影响分别在单变量和多变量COX风险模型中被评估为主要暴露。对其他可能的危险因素进行单因素分析，发现有意义的因素进入多因素分析。495例患者的平均体重为63公斤。97例(19.6%)患者发生了替诺福韦相关的肾功能障碍(发生率：每100人年10.5例)。单因素分析显示，替诺福韦相关性肾功能障碍的发生率与较小的体重和体重指数显著相关(每减少5 kg体重，HR = 1.23；95%CI，1.10~1.37；p<；0.001)(每减少1 kg/m2，HR = 1.14；95%CI，1.05~1.23；p = 0.001)。高龄、高基线EGFR、低血肌酐、低CD4计数、高HIV病毒载量、并发肾毒性药物、丙型肝炎感染和当前吸烟也与替诺福韦相关的肾功能障碍相关。多因素分析显示体重偏小是显著危险因素(调整后HR = 为1.13；95%可信区间为1.01~1.27；p = 为0.039)，而小体重指数为边际意义(调整后HR = 为1.07；95%CI为1.00~1.16；p = 为0.058)。替诺福韦相关性肾功能不全在日本患者中的发生率很高。体重小被确定为替诺福韦相关肾功能障碍的独立危险因素。对于使用替诺福韦治疗的体重较小的患者，建议密切监测肾功能。
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. 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. 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/m2 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). 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.
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影响因子：
1
作者：
Chaisiri, Kessarin;Bowonwatanuwong, Chureeratana;Kiertiburanakul, Sasisopin
通讯作者：
Kiertiburanakul, Sasisopin
影响因子：
3.8
作者：
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DOI：
10.1097/qai.0b013e31815acab8
发表时间：
2008-01-01
影响因子：
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作者：
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通讯作者：
Cheng, Andrew K.
影响因子：
1.5
作者：
Gatanaga, Hiroyuki;Tachikawa, Natsuo;Oka, Shinichi
通讯作者：
Oka, Shinichi
影响因子：
4.9
作者：
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通讯作者：
Urien, S