A Assessment Study of Trigger for Detecting Nephrotoxicity from Tenofovir Disoproxil Fumarate

Abstract

Background: Tenofovir-induced nephrotoxicity is detected from eGFR, urine glucose, proteinuria, serum potassium, and urine phosphate. Serum phosphorus is another standard diagnosis. Unfortunately, some patients are not investigated for this latter test as it is not included in the Universal Coverage benefit package of National Health Security Office.

Objective: To develop a monitoring system that includes a trigger tool and evaluate its effectiveness in detecting tenofovir-induced nephrotoxicity.

Method: Part 1 A retrospective analysis was performed on data from a database between January 2020 and December 2021. The effectiveness of the trigger was calculated based on its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Part 2 A focus group of an HIV clinic's interdisciplinary team was used to gather consensus on workflow improvement.

Result: Among 1,059 visits, 6.98% of them involved tenofovir-induced nephrotoxicity. Serum phosphorus functions as the best trigger. When this trigger was used along with eGFR and urine sugar, the efficiency of trigger tools is 100%. The focus group resulted in the development of a procedure for monitoring serum phosphorus levels in all patients whose tested positive for proteinuria or sugar in the urine.

Conclusion: Urine sugar, eGFR, and serum phosphorus, all can be used to detect tenofovir-induced nephrotoxicity. The workflow for monitoring tenofovir-induced nephrotoxicity has been developed through interdisciplinary collaboration, and as a consequence, it is straightforward and efficient, which can increase patient safety.