Tenofovir disoproxil fumarate associated nephrotoxicity: a retrospective cohort study at two referral hospitals in Namibia

Francis Kalemeera, Brian Godman, Andy Stergachis, Tim Rennie

Research output: Contribution to journalArticle


Introduction: The incidence and risk factors of tenofovir (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV. Methodology: A retrospective cohort study among HIV infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR <50 ml/min/1.73m2. Results: 10 387 patients were included: 11.4% (n=1,182) experienced the decline in eGFR. Of these, 0.6% (n=62) migrated to eGFR stages IV and V. The incidence was 4.5 (95%CI: 4.3 – 4.8) per 100 patient years. RI developed in 400 patients for an incidence rate of 2.4 (95%CI: 2.2 – 2.6) cases per 100 patient years. Risk factors with effect sizes >2.0, for decline-in-eGFR were baseline eGFR >60 (aHR=15.6); hyperfiltration (aHR=5.0); and pregnancy (aHR=2.4); while for RI they were hyperfiltration (aHR=4.1) and pregnancy (aHR=29). Conclusion: The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI.
Original languageEnglish
Number of pages18
JournalPharmacoepidemiology and Drug Safety
Publication statusAccepted/In press - 21 Aug 2020


  • tenofovir disoproxil fumarate
  • nephrotoxicity
  • Namibia

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