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Prospective study of renal function in HIV-infected pediatric patients receiving tenofovir-containing HAART regimens

Soler-Palacín, Perea,*; Melendo, Susanaa,*; Noguera-Julian, Antonib; Fortuny, Claudiab; Navarro, María Lc; Mellado, María Jd; Garcia, Lourdese; Uriona, Soniaf; Martín-Nalda, Andreaa; Figueras, Concepcióa

doi: 10.1097/QAD.0b013e328340fdca
Clinical Science

Aim: To describe the impact of tenofovir disoproxil fumarate (TDF) use on renal function in HIV-infected pediatric patients.

Design: It is a prospective, multicenter study. The setting consisted of five third-level pediatric hospitals in Spain. The study was conducted on patients aged 18 years and younger who had received TDF for at least 6 months. The intervention was based on the study of renal function parameters by urine and serum analyses. The main outcome measures were renal function results following at least 6 months of TDF therapy.

Results: Forty patients were included (32 were white and 26 were diagnosed with AIDS). Median (range) duration of TDF treatment was 77 months (16–143). There were no significant changes in the estimated creatinine clearance. Urine osmolality was abnormal in eight of 37 patients, a decrease in tubular phosphate absorption was documented in 28 of 38 patients, and 33 of 37 patients had proteinuria. A statistically significant decrease in serum phosphate and potassium concentrations was observed during treatment (P = 0.005 and P = 0.003, respectively), as well as a significant relationship between final phosphate concentration and tubular phosphate absorption (P = 0.010). A negative correlation was found between phosphate concentration and time on TDF.

Conclusions: TDF use showed a significant association with renal tubular dysfunction in HIV-infected pediatric patients. Periodic assessment of tubular function may be advisable in the follow-up of this population.

aPediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Spain

bInfectious Diseases Unit, Pediatric Department, Sant Joan de Déu Hospital-Universitat de Barcelona, Barcelona, Spain

cPediatric Infectious Diseases Unit, Gregorio Marañon University General Hospital, Spain

dPediatric Infectious and Tropical Diseases Unit, Carlos III Hospital, Madrid, Spain

ePediatric Department, Hospital de Mataró, Mataró, Spain

fPreventive Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain.

*These two authors contributed equally to this work.

Received 1 July, 2010

Revised 6 September, 2010

Accepted 23 September, 2010

Correspondence to Pere Soler-Palacin, MD, Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 93 489 3140; fax: +34 93 489 3039; e-mail: psoler@vhebron.net, 34660psp@comb.cat

© 2011 Lippincott Williams & Wilkins, Inc.