Preventable factors linked to indinavir-associated renal complications

Indinavir-associated renal complications might be reduced by careful attention to such preventable factors as dehydration, according to a report from the September issue of the Journal of Antimicrobial Chemotherapy.

Indinavir-associated renal complications range from asymptomatic crystalluria to severe renal colic from nephrolithiasis, the authors explain, but the actual incidence of such complications has not been studied in a large clinical population.

Dr. Philippa J. Easterbrook from King’s College Hospital in London, UK and colleagues analysed the incidence and risk factors of indinavir-associated renal complications (IRC) in 781 patients from two large HIV centres in London.

“This study represents the largest and most comprehensive analysis to date of risk factors for the development of IRC,” the investigators write.

Fifty-seven patients (7.3%) experienced IRC after a median 37 weeks of treatment with indinavir, the authors report, a rate only slightly higher than that reported from clinical trials (2.5% to 5%).

More than a quarter of cases (15 patients) had an identifiable precipitant, the report indicates, including events likely to lead to fluid depletion (10), changes in indinavir dose from 800 mg three times daily to 1200 mg twice daily (4), and inadvertent overdose (1).

IRC was also associated with increasing duration of treatment with indinavir, the researchers note. Moreover, the concomitant use of acyclovir increased the risk of IRC by 76%.

Nearly two thirds of the patients required hospitalisation for IRC, the results indicate, but only 14 (39%) required agrological intervention and only 7 patients (12%) required permanent cessation of indinavir therapy.

The authors conclude that careful monitoring for common precipitants, particularly during concomitant use of acyclovir, might prevent many cases of IRC.