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

Citation

Chabala, Freeman (2021), Acute kidney disease among Zambian adults initiating tenoforvir disoproxil fumarate-based antiretroviral therapy, Dryad, Dataset, https://doi.org/10.5061/dryad.51c59zw88

Abstract

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.

Methods

Participants were systematically randomly sampled to include every other Antiretroviral-naive adult that clinicians initiated on tenofovir disoproxil fumarate based therapy. The study was a prospective observational cohort of 205 participants. The study was done within the confines of standard clinical practice, where only candidates that the clinicians initiated on TDF-based therapy were invited to participate in the study. The investigators had no control over whom the clinicians initiated on therapy; they initiated participants based on the Zambian national ART treatment guidelines and their expert clinical discretion of the risk for TDF-associated nephrotoxicity.

Usage Notes

1. There are no missing values in the dataset.

2. Age has been categorised as below 20, above 50 and the ages in between those categorised in 5 years. Ages beyond those extremes may be identifiable.

3. BMI categorised as less than 18.5, less than 25, less than 30 and above 30 

Funding

Fogarty International Center, Award: D43 TW009744