BP Control May Be More Important in Kidney Injury Prevention With TDF Therapy

BP Control May Be More Important in Kidney Injury Prevention With TDF Therapy
BP Control May Be More Important in Kidney Injury Prevention With TDF Therapy

SAN DIEGO, CA—Administering diuretics does not increase acute kidney injury (AKI) risk among HIV-positive patients who are taking tenofovir disoproxil fumarate (TDF), and controlling blood pressure may be a more important consideration when it comes to preventing AKI, suggests a retrospective analysis reported at IDWeek 2015.

“Acute kidney injury is common among HIV-infected adults with hypertension, emphasizing the importance of renal function monitoring and appropriate dosing of renally-excreted medications,” explained lead study author Martin Ucanda, MD, Infectious Diseases, Howard University Hospital, Washington, D.C. “Diuretic therapy did not predispose patients to AKI, even in the presence of TDF, thereby suggesting that control of blood pressure may be more important than choice of anti-hypertensive medication in preventing AKI in HIV-infected adults.”

Hypertension and TDF are known risk factors for acute kidney injury among HIV-infected patients, but it has not been clear whether or not the choice of anti-hypertensive therapy might affects AKI incidence, Dr. Ucanda noted.

To find out, the coauthors explored the effects of diuretics on the incidence of AKI among HIV-positive adults who were treated with and without TDF by conducting a retrospective analysis of adult patients on highly-active antiretroviral therapy (HAART). The patients had been enrolled between January 1, 2011 and December 31, 2014 in the D.C. Cohort, a longitudinal cohort of HIV-infected participants cared for in Washington, DC.

For the analysis, AKI was defined as a serum creatinine (Cr) increase ≥0.3mg/dL or a decrease in estimated glomerular filtration rate by 50%, within 3 months. (Data for patients with fewer than two recorded Cr results were excluded from analysis.) The coauthors considered AKI events to be associated with medication when they occurred within 28 days of the patient taking the medication, and the duration of medication ≥14 days.

“Hypertension was associated with developing AKI (adjusted hazard ratio [aHR] 1.2; 95% CI: 1.0, 1.4) while receipt of TDF was not (aHR 1.0; 95% CI: 0.8, 1.2),” Dr. Ucanda reported. “Among 520 adults on both HAART and anti-hypertensives, over half were on diuretics. The combination of TDF and a diuretic did not increase the risk of AKI.” Demographic, medical- and medication-history AKI risk factors were recorded and included in statistical analyses to control for potential confounding. 

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