Background: Hypertension and receipt of tenofovir disoproxil fumarate (TDF) are known risk factors for acute kidney injury (AKI) among HIV-infected patients. However, it is unclear whether the choice of anti-hypertensive therapy affects the incidence of AKI in this population. We explored the effect of diuretics on the incidence of AKI in HIV-infected adults treated with and without TDF.
Methods: We conducted a retrospective analysis of patients enrolled in the DC Cohort, a longitudinal cohort of HIV-infected participants cared for in Washington, DC, from 1/1/11 to 12/31/14. We included adults who were on highly active antiretroviral therapy (HAART). AKI was defined as a rise in serum creatinine (Cr) by ≥ 0.3 mg/dL or a decrease in estimated glomerular filtration rate by 50% within 3 months. An AKI event was associated with medication use if it occurred within 28 days of taking the medication and the medication duration was ≥14 days. Data on demographics, medical history and medications were used to control for known risk factors of AKI. Patients who died, became inactive, or developed AKI before the study start were excluded, as were patients with <2 recorded Cr results. We determined correlates of AKI using descriptive and multivariate adjusted Cox proportional hazard analyses.
Results: Of 4504 adults on HAART, 75% were African-American, 74% male, and the median age was 48 years (interquartile range, 39-55). 3700 (82%) were on TDF, 1384 (31%) had hypertension, and 578 (13%) developed AKI. Hypertension was associated with developing AKI (adjusted hazard ratio [aHR] 1.3, confidence interval [CI] 1.1-1.6) while receipt of TDF was not (aHR 0.9, CI 0.7-1.1). Among 486 adults on both HAART and anti-hypertensives, 262 (54%) were on diuretics. The combination of TDF and a diuretic did not increase the risk of AKI (aHR 1.0, CI 0.6-1.7).
Conclusion: 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. 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.
J. Gajjala, None
S. Doshi, None