菲律宾一家三级医院接受替诺福韦治疗的人类免疫缺陷病毒感染者肾毒性发生率

Marja Bernardo-Buensalido, C. Abad
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摘要

目的:我们旨在确定菲律宾人免疫缺陷病毒(HIV)患者使用富马酸替诺福韦二氧吡酯(TDF)后肾毒性的发生率和危险因素。方法:回顾性队列研究;我们回顾了2004年1月至2016年12月在菲律宾大学-菲律宾总医院(UP-PGH)诊所接受TDF治疗的艾滋病毒成人的医疗记录。肾毒性定义为肾小球滤过率(eGFR)至少下降20%。收集了相关的人口统计和实验室数据。进行统计学分析比较各组间的特征。采用Kaplan-Meier法测定肾毒性随时间的发生率,计算肾毒性的发生率密度率。结果:纳入654例患者,平均年龄29岁(18-69岁),男女比例为72:1。肾毒性发生率为51.38%,密度率为11.05 /万人日。Kaplan Meier分析显示,20.4个月时肾毒性发生率为50%。协变量的Cox回归模型显示,低CD4是预测随后20% eGFR下降的重要协变量。结论:随着时间的推移,TDF可能有助于GFR的下降。一半服用TDF的患者在20.5个月时出现轻度肾毒性。临床医生必须考虑长期使用的潜在肾毒性风险,特别是在CD4计数低的年轻患者中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence of Nephrotoxicity among People Living with Human Immunodeficiency Virus on Tenofovir Treatment in a Tertiary Hospital in the Philippines
Objective: We aimed to determine the incidence and risk factors of nephrotoxicity among Filipino human immunodeficiency virus (HIV) patients on tenofovir disoproxil fumarate (TDF). Methods: Retrospective cohort study; we reviewed medical records of HIV adults on TDF in the University of the Philippines-Philippine General Hospital (UP-PGH) clinic from January 2004 - December 2016. Nephrotoxicity was defined as at least a 20% decline in estimated glomerular filtration rate (eGFR). Relevant demographic and laboratory data were collected. Statistical analysis was performed to compare characteristics between groups. Kaplan-Meier method was used to determine incidence rate over time, and incidence density rates of nephrotoxicity were calculated. Results: 654 patients were included, with mean age of 29 years (18-69) and male-female ratio of 72:1. Nephrotoxicity incidence was 51.38% with a density rate of 11.05 per 10,000 person days. Kaplan Meier analysis showed probability of nephrotoxicity of 50% at 20.4 months. Cox regression modeling of covariates revealed low CD4 as a significant covariate for predicting a subsequent 20% eGFR decline. Conclusion: TDF may contribute to a decline in GFR over time. Half of patients taking TDF developed mild nephrotoxicity by 20.5 months. Clinicians must consider the potential risk of nephrotoxicity with prolonged use especially among young patients with low CD4 counts.
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