Incidence and Risk Factors for Tenofovir-Associated Renal Function Decline Among Thai HIV-Infected Patients with Low-Body Weight
Incidence and Risk Factors for Tenofovir-Associated Renal Function Decline Among Thai HIV-Infected Patients with Low-Body Weight
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DOI：
10.2174/157016210793499259
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发表时间：
2010-10-01
影响因子：
1
通讯作者：
Kiertiburanakul, Sasisopin
中科院分区：
文献类型：
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作者：
Chaisiri, Kessarin;Bowonwatanuwong, Chureeratana;Kiertiburanakul, Sasisopin
目的：我们旨在确定泰国 HIV 感染者中富马酸替诺福韦二吡呋酯 (TDF) 相关肾功能下降的发生率和影响因素。方法：进行了回顾性和前瞻性队列研究。我们招募了已启动 TDF 的 HIV 感染成年人。肾功能下降的定义是肾小球滤过率 (GFR) 较基线下降 25%。确定与肾功能下降相关的因素。 结果：共有405名中位体重（四分位距，IQR）为56.5（50.5-65.0）kg的患者入组。除四人（99%）外，其余所有人都是接受过抗逆转录病毒治疗的患者。接受 TDF 的中位持续时间 (IQR) 为 16 (8-21) 个月。其中，78 名（19.3%）患者的 GFR 降低了 25%，发病率为每 100 人年 16.2 例。根据 Kaplan-Meier 生存分析，GFR 下降 25% 的中位时间为 28 [95% 置信区间 (CI) 25.2-30.8] 个月。通过多元逻辑回归，较低体重[比值比 (OR) 1.15 每 5 kg，95% CI 1.00-1.33]、较低体重指数 (BMI)（OR 2.26 每 1 kg/m(2)，95% CI 1.74-2.94）、基线 GFR（OR 1.62 每 10 ml/min/1.73m(2)，95% CI 1.39-1.88）、蛋白酶抑制剂（OR 2.12，95% CI 1.15-3.92）和肾毒性药物（OR 3.16，95% CI 1.44-6.98）是与 GFR 下降 25% 相关的统计学显着因素。结论：该研究显示，低体重和 BMI 患者中 TDF 相关肾功能下降的发生率较高。其他危险因素包括基线 GFR、接受蛋白酶抑制剂和肾毒性药物。对于具有这些危险因素的患者，有必要密切监测肾功能。
Objectives: We aimed at determining the incidence and factors for tenofovir disoproxil fumarate (TDF)-associated renal function decline among Thai HIV-infected patients.Methods: Retrospective and prospective cohort studies were conducted. We enrolled HIV-infected adults who had initiated TDF. Renal function decline was defined by a decrease of 25% in glomerular filtration rate (GFR) from the baseline. Factors associated with the renal function decline were determined.Results: A total of 405 patients with a median (interquartile range, IQR) body weight of 56.5 (50.5-65.0) kg were enrolled. All but four (99%) were antiretroviral treatment-experience patients. A median (IQR) duration of receiving TDF was 16 (8-21) months. Of these, 78 (19.3%) patients had a 25% decrease in GFR with the incidence rate of 16.2 per 100 person-years. By Kaplan-Meier survival analysis, median time to a 25% decrease in GFR was 28 [95% confidence interval (CI) 25.2-30.8] months. By multiple logistic regression, lower body weight [odds ratio (OR) 1.15 per 5 kg, 95% CI 1.00-1.33], lower body mass index (BMI) (OR 2.26 per 1 kg/m(2), 95% CI 1.74-2.94), baseline GFR (OR 1.62 per 10 ml/min/1.73m(2), 95% CI 1.39-1.88), protease inhibitor (OR 2.12, 95% CI 1.15-3.92), and nephrotoxic drug (OR 3.16, 95% CI 1.44-6.98) were statistically significant factors associated with a 25% decrease in GFR.Conclusions: The study revealed high incidence of TDF-associated renal function decline among patients with low-body weight and BMI. Additional risk factors were baseline GFR, receiving protease inhibitor, and nephrotoxic drugs. Close monitoring of renal function is warranted among patients with these risk factors.