The potential effect of using the Cockcroft-Gault method on tenofovir-associated renal impairment reports and on clinical decisions regarding tenofovir use in individual patients : implications for the future

Kalemeera, Francis and Cockeran, Marike and Mubita, Mwangana and Kibuule, Dan and Naikaku, Ester and Massele, Amos and Godman, Brian (2017) The potential effect of using the Cockcroft-Gault method on tenofovir-associated renal impairment reports and on clinical decisions regarding tenofovir use in individual patients : implications for the future. Journal of Infectious Diseases & Preventive Medicine, 5 (3). 1000170. ISSN 2329-8731

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    Abstract

    Introduction: In Namibia, the Cockcroft-Gault (C-G) method is recommended for monitoring renal function in HIV patients receiving tenofovir disoproxil fumarate (TDF)-containing combination antiretroviral therapy (cART). However, there are concerns with the potential over-reporting of TDF-associated renal impairment. Methods: Retrospective study comparing the renal function of patients receiving 2nd line cART with either C-G or Chronic Kidney Disease-Epidemiology (CKD-EPI) methods. Results: 71 patients were included. The majority (62%) received TDF-containing 1st line ART. All received 2nd-line cART containing TDF/ lamivudine (3TC)/ zidovudine (AZT) and LPV/r. Before switching to 2nd-line cART, 40.8% and 8.5% had abnormal eGFR according to C-G and CKD-EPI methods respectively. During 2nd-line cART, 47.9% and 7% of patients had abnormal eGFR by C-G and CKD-EPI methods, respectively, and 4.1% and 2.8% respectively experienced a decline in eGFR. There was a significant lack of agreement between the two methods. Conclusion: The C-G method has the potential to report more cases of TDF-associated renal impairment. Consequently, national guidelines in Namibia and other pertinent countries should be reviewed if this is the recommended method for monitoring renal function.