We assessed the progress of renal damage after discontinuation of tenofovir (TDF) in patients who started therapy with normal renal parameters. Normal local reference values were as follows: estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation (MDRD), ≥60mL/min/1.73m2; creatinine, ≤1.20mg/dL; serum phosphate: ≥2.69mg/dL; proteinuria: <30mg/dL, and glycosuria: <20mg/dL in nondiabetic patients. A logistic regression analysis was used to evaluate factors related to normalization of renal function.We included 183 patients; 85% were male, and median (IQR) age was 44 (40-50). years. Time on TDF was 39 (22-63). months. After 22 (13-49.5). months from TDF discontinuation, renal parameters returned to normal values in 59% of patients, improved (without reaching normal values) in 9.8%, and did not improve in 31%. Median time until normalization was 4 (2-15.75). months, and time to maximum improvement in patients whose values did not return to normal was 14 (8.75-27.75). months. Follow-up was <12. months in 30% of the patients who did not improve. The only factors significantly associated with normalization of renal parameters were nadir CD4 T-cell count (p= 0.034; OR = 1.002, per 1 cell of increase) and CD4 T-cell count at the end of therapy with TDF (p= 0.030; OR = 1.033, per 1 cell of increase). Reversibility of renal damage was prompt and complete in 59% of patients receiving TDF-containing regimens and was associated with a higher nadir and current CD4+ T-cell count, suggesting a role of preserved cellular immunity in renal recovery in this population. © 2012 Elsevier B.V.
- Renal impairment