Abstract: FR-PO082

Factors Associated with the Development of AKI in Patients Treated with Tenofovir Disoproxil Fumarate – The AKIT Study

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Liew, Adrian, Tan Tock Seng Hospital, Singapore, Singapore
  • Lim, Ru Sin, Tan Tock Seng Hospital, Singapore, Singapore
  • Yeo, See Cheng, Tan Tock Seng Hospital, Singapore, Singapore
Background

Acute kidney injury (AKI) from renal tubular mitochondrial toxicity had been reported with Tenofovir Disoproxil Fumarate (TDF) treatment. Whilst impaired baseline renal function had been consistently found to be associated with TDF-related AKI, studies looking at other predictors for renal dysfunction had demonstrated conflicting results. The current study aims to determine the risk factors for the development of AKI in the largest known cohort of Asian patients undergoing TDF treatment for HIV and/or Hepatitis B (HBV).

Methods

This is a retrospective cohort study of 1700 patients treated with TDF from 2006-2015. AKI was identified using KDIGO definition, and time to AKI was defined as time from TDF initiation to renal dysfunction or when censored. Risk factors for AKI were compared using Cox regression, between patients who developed AKI and in whom renal function remained stable.

Results

Of the 1700 patients in the study population (87% Males, 75% Chinese, Age 44.5±12.6 years), TDF was initiated for treatment of HBV (n=185; 10.8%), HIV (n=1412; 83.1%) or HBV-HIV co-infection (n=103; 6.1%). AKI occurred in 226 (13.3%) patients, with a median time to AKI of 23.5 months. Risk factors for AKI included older age (HR=1.028, 95%CI [1.016, 1.039], p<0.0001), lower weight (HR=0.984, 95%CI [0.974, 0.995], p=0.004), diabetes (HR=2.000, 95%CI [1.405, 2.849], p<0.0001), hypertension (HR=1.823, 95%CI [1.349, 2.464], p<0.0001), Charlson score (HR=1.217, 95%CI [1.104, 1.342], p<0.0001), use of ACE-inhibitors (HR=2.125, 95%CI [1.420, 3.180], p<0.0001) and diuretics (HR=2.894, 95%CI [1.484, 5.643], p=0.002), and lower CD4 counts (HR=0.997, 95%CI [0.996, 0.998], p<0.0001). A lower baseline serum creatinine below 75umol/L appears to be protective (HR=0.936, 95%CI [0.924, 0.949], p<0.0001) whilst creatinine levels above 75umol/L increases the risk of AKI (HR=1.012, 95%CI [1.006, 1.018], p<0.0001).

Conclusion

AKI is not uncommon with TDF use. The incidence and association with impaired baseline renal function are consistent with published literature, though the threshold creatinine level of 75umol/L is a new finding. Predictors of a frail health state and factors that may affect baseline renal function appears to increase the risk of AKI. The use of ACE inhibitors and diuretics with TDF-associated AKI requires further investigation.