Acute kidney disease among Zambian adults initiating tenoforvir disoproxil fumarate-based antiretroviral therapy

Tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy ART is
the commonest first-line regimen worldwide; however, it causes
nephrotoxicity that primarily occurs in the first three to six months
following initiating therapy. The TDF-associated nephrotoxicity can
manifest as AKI that may lead to direct complications including permanent
loss of kidney function, chronic kidney disease (CKD), end-stage kidney
disease (ESKD) requiring dialysis and to indirect complications such as
cardiovascular diseases.Tenofovir disoproxil fumarate (TDF)-based
antiretroviral therapy ART is the commonest first-line regimen worldwide;
however, it causes nephrotoxicity that primarily occurs in the first three
to six months following initiating therapy. The TDF-associated
nephrotoxicity can manifest as AKI that may lead to direct complications
including permanent loss of kidney function, chronic kidney disease (CKD),
end-stage kidney disease (ESKD) requiring dialysis and to indirect
complications such as cardiovascular diseases. We prospectively followed
205 ART-naïve Zambian adults at the adult infectious disease research
centre (AIDC) in Lusaka for three months from the day of initiating
TDF-based therapy to determine the incidence of TDF-associated
nephrotoxicity. We defined TDF-associated nephrotoxicity as meeting any of
the following criteria: 1) An episode of estimated glomerular filtration
rate (eGFR)< 60ml/ min/1.73m2 for< 3 months, 2) reduced eGFR
by> 35% for< 3 months or 3) increased serum creatinine
by> 50% in 3 months. A total of 45 (22%) developed TDF-associated
nephrotoxicity; but there was no statistically significant difference in
the demographics, clinical and laboratory parameters between the patients
that did and those that did not suffer nephrotoxicity. We concluded that a
mere assessment of baseline clinical and laboratory characteristics was
not enough to distinguish or classify patients’ risk for TDF-associated
nephrotoxicity.