Neither current nor recent use of tenofovir or any other antiretroviral therapy (ART) predicted advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD) in a study or more than 35,000 adults with HIV infection.
Some antiretrovirals, including tenofovir, have been linked to moderate CKD in several studies. But their association with advanced CKD or ESRD had not been well studied until this analysis of the D:A:D cohort.
D:A:D is an ongoing prospective study of HIV-positive adults in Europe, the United States, and Australia. This analysis involved 35,192 D:A:D participants who had at least three estimated glomerular filtration rates (eGFRs) after February 2004. All patients were followed until they had advanced CKD or ESRD, until 6 months after their last visit, or until February 2012. The investigators defined advanced CKD as two eGFRs at or below 30 mL/min at least 3 months apart. They defined ESRD as dialysis for at least 3 months or kidney transplantation.
The study group had a median age of 41 years at their first eGFR measurement. During a median follow-up time exceeding 6 years, CKD or ESRD developed in 135 people (0.4%) to yield an incidence of 0.67 per 1000 person-years (95% confidence interval [CI] 0.56 to 0.79). Over time, D:A:D cohort members were particularly likely to stop tenofovir as eGFR fell, a finding indicating that clinicians were aware of the kidney function risk with tenofovir.
After statistical adjustment for kidney function risk factors, people who had taken but stopped tenofovir had a rate of advanced CKD or ESRD identical to that of people who had never taken tenofovir (adjusted incidence rate ratio [aIRR] 1.00, 95% CI 0.66 to 1.51). Compared with people who never took tenofovir, people currently taking tenofovir had more than a 75% lower rate of advanced CKD or ESRD (aIRR 0.23, 95% CI 0.13 to 0.14). This analysis revealed no associations between current or recent use of other antiretrovirals and CKD or ESRD.