Abstract PS1/1 |
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| | Acute Kidney Injury Caused by Tenofovir Disoproxil Fumarate and Diclofenac Co-administration | | | | M. Bickel1, P. Khaykin2, C. Stephan2, K. Schmidt2, T. Lutz1, P. Gute1, A. Haberl2, H.R. Brodt2, O. Jung3 | 1Infektiologikum, Frankfurt, Germany, 2HIVCENTER, Goethe University, Infectious Disease, Frankfurt, Germany, 3Goethe University, Nephrology, Frankfurt, Germany | | Objectives: The renal
elimination of tenofovir (TFV) may be subject to renal
drug-drug interactions that may increase the risk of kidney injury. Case
reports indicated that diclofenac might increase TFV-associated nephrotoxicty
by drug-drug interaction leading to increased intracellular TFV concentration
in proximal tubular cells.
Methods:
Retrospective analysis of all patients from the
Frankfurt HIV Cohort (FHC) that had diclofenac prescriptions between January
2008 and June 2012.
Results: Among 89 patients with diclofenac use, 61
patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28
patients (31.5%) were treated with TDF-sparing combination antiretroviral
therapy (cART). Thirteen
patients (14.6%) developed acute kidney injury (AKI) shortly after initiating
diclofenac. AKI occurred exclusively in TDF treated patients, although all had
a previously stable renal function. All cases were accompanied by new onset of at least two parameters
indicating proximal tubular damage, such as normoglycemic-glucosuria and
hypophosphatemia. TFV-nephrotoxicity was proven by renal biopsy in four cases. Additionally
11.5% of patients on TDF treatment newly developed proximal tubular damage,
while having preserved glomerular filtration rate. In contrast, diclofenac did
not affect renal function in patients with TDF-sparing cART, as only one case
of isolated hypophatemia was observed in these patients. In univariate analysis risk
factors for AKI were TDF-containing cART (p=0.0076) and pre-existing
hypophosphatemia (p=0.0086).
Conclusion:
Drug-drug interaction caused by diclofenac could
enhance TFV-nephrotoxicity. Diclofenac should be used with caution in patients
on TDF therapy, especially in those with hypophosphatemia. Our findings need to
be confirmed in larger studies. |
Assigned speakers: Markus Bickel , Infektiologikum , Frankfurt , Germany
| Assigned in sessions: 17.10.2013, 10:30-12:30, Parallel Session, PS1, Prevention and Management of Co-Morbidities - Joint Session with the 15th International Workshop on Co-Morbidities & Adverse Drug Reactions in HIV, Bozar (Plenary Hall)
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