Monteagudo-Chu Maricelle O, Chang Mei H, Fung Horatio B, Bräu Norbert
Clinical Pharmacy Specialist-Emergency Medicine and Infectious Diseases, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA.
J Pharm Pract. 2012 Oct;25(5):552-9. doi: 10.1177/0897190012442718. Epub 2012 May 2.
Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.
关于以估计肾小球滤过率（eGFR）衡量的替诺福韦长期肾毒性以及慢性肾脏病（CKD）进展至晚期的数据较为稀少。本研究的目的是使用阿巴卡韦作为对照，确定HIV感染患者使用替诺福韦后发生肾功能损害的发生率。在一家三级医疗中心，所有1998年至2008年开始使用替诺福韦或阿巴卡韦且基线CKD分期为0或1期（CKD-1）、治疗期间至少有1次随访eGFR测量值的HIV感染患者被纳入本回顾性分析。使用Kaplan-Meier分析比较进展至CKD 2至5期的情况。接受替诺福韦治疗的患者进展至CKD-2和CKD-3的频率高于接受阿巴卡韦治疗的患者（CKD-2，2年精算频率，48.8%对23.7%；P<0.001，对数秩检验；CKD-3，5.8%对0.0%；P = 0.028）。替诺福韦组只有1例患者进展至CKD-4，无患者进展至CKD-5。替诺福韦治疗是与进展至CKD-2（风险比[HR]，2.12；95%置信区间[CI]：1.41 - 3.18；P<0.001）和CKD-3（HR，4.91；95% CI，1.02 - 23.7；P = 0.048）相关的唯一独立因素。在HIV感染患者中，替诺福韦长期治疗与轻至中度肾毒性相关，且显著高于阿巴卡韦治疗的患者。
