Evaluation of kidney function in HIV‐infected patients receiving an antiretroviral regimen containing one or two inhibitors of the tubular secretion of creatinine

Objectives The aim of this study was to determine the evolution of renal function in patients receiving one or two inhibitors, according to different baseline factors. Some antiretroviral drugs such as rilpivirine (RPV), dolutegravir (DTG), or cobicistat (COBI), interact with the tubular secretion o...

Full description

Saved in:
Bibliographic Details
Published in:HIV medicine Vol. 20; no. 10; pp. 648 - 656
Main Authors: Casado, JL, Monsalvo, M, Vizcarra, P, Fontecha, M, Serrano‐Villar, S, Moreno, S
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01-11-2019
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives The aim of this study was to determine the evolution of renal function in patients receiving one or two inhibitors, according to different baseline factors. Some antiretroviral drugs such as rilpivirine (RPV), dolutegravir (DTG), or cobicistat (COBI), interact with the tubular secretion of creatinine, but there are no data about their impact in renal function evaluation in patients with renal disease or when these drugs are used concomitantly. Methods A prospective cohort study was carried out in HIV‐infected patients who switched to a dual regimen including DTG, RPV or darunavir/COBI, separately or in combination. The primary endpoint was the evolution of the serum creatinine‐based estimated glomerular filtration rate (eGFR‐scr). A control group not receiving any transporter inhibitor was included. Results A total of 288 patients on different dual regimens were included (DTG + RPV, 92; DTG + darunavir/COBI, 23; DTG, 26; COBI, 19; control group, 128). In patients receiving two transporter inhibitors, eGFR‐scr decreased by a mean of −8.4 mL/min/1.73 m2, similar to that observed with the separate use of DTG or COBI (mean of both groups, −8.6 mL/min/1.73 m2), while eGFR‐scr improved in the control group. Similar evolution of proteinuria and tubular dysfunction was observed in all the groups, and there were no significant changes in the cystatin C‐based eGFR. Mean eGFR‐scr change inversely correlated with baseline eGFR‐scr value (r = −0.39; P < 0.01), with a lower eGFR‐scr decrease in patients with chronic kidney disease. Conclusions Similar eGFR‐scr decreases were observed in patients using different antiretroviral drugs inhibiting the tubular transport of creatinine, separately or in combination, with no alterations in proteinuria or cystatin C‐based eGFR. The lack of additional changes when the drugs were used in combination, and the lower impact in cases of previous chronic kidney disease, suggest that there are compensatory mechanisms for creatinine secretion.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.12784