富马酸替诺福韦二吡呋酯相关性肾毒性：纳米比亚两家转诊医院的回顾性队列研究。

Tenofovir disoproxil fumarate associated nephrotoxicity: a retrospective cohort study at two referral hospitals in Namibia.

机构信息

Department of Pharmacology and Therapeutics, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia.

Clinical Pharmacology, Pharmacoeconomics, Karolinska Institute (Sweden); Sefako Makgatho Health Sciences University (South Africa); Strathchlyde Institue of Pharmacy and Biomedical Sciences (Scotland).

出版信息

Pharmacoepidemiol Drug Saf. 2021 Feb;30(2):189-200. doi: 10.1002/pds.5125. Epub 2020 Oct 2.

DOI:10.1002/pds.5125

PMID:33006803

Abstract

INTRODUCTION

The incidence and risk factors of tenofovir disoproxil fumarate (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV.

METHODOLOGY

A retrospective cohort study among HIV-infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR <50 mL/min/1.73m .

RESULTS

10 387 patients were included: 11.4% (n = 1182) experienced the decline in eGFR. Of these, 0.6% (n = 62) migrated to eGFR stages IV and V. The incidence was 4.5 (95% CI: 4.3-4.8) per 100 patient years. RI developed in 400 patients for an incidence rate of 2.4 (95% CI: 2.2-2.6) cases per 100 patient years. Risk factors with effect sizes >2.0, for decline-in-eGFR were baseline eGFR >60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29).

CONCLUSION

The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI.

摘要

简介

在纳米比亚，富马酸替诺福韦二吡呋酯（TDF）相关肾损伤（RI）的发病率和危险因素尚不清楚，而 TDF 包含的 ART 方案被用作 HIV 的一线治疗。

方法

对两家中级医院的 HIV 感染患者进行回顾性队列研究。如果肾小球滤过率（eGFR）下降≥25%，并导致 eGFR 下降到更低的阶段，则认为是有意义的。新诊断的 RI 定义为 eGFR <50 mL/min/1.73m 。

结果

共纳入 10387 例患者：11.4%（n=1182）出现 eGFR 下降。其中，0.6%（n=62）迁移到 eGFR 第四和第五阶段。发病率为每 100 患者年 4.5（95%CI：4.3-4.8）。400 例患者发生 RI，发病率为每 100 患者年 2.4（95%CI：2.2-2.6）例。对 eGFR 下降有影响的风险因素中，大小>2.0 的因素包括基线 eGFR>60（aHR=15.6）；高滤过（aHR=5.0）；妊娠（aHR=2.4）；而 RI 的风险因素为高滤过（aHR=4.1）和妊娠（aHR=29）。