The development of management and surveillance model for Tenofovir disoproxil fumarate (TDF) induced nephrotoxicity in HIV infected patients at Nongphok hospital

Abstract

Purposes : To investigate the incidence, develop, implement, and evaluate a model for managing and monitoring kidney toxicity from Tenofovir Disoproxil Fumarate (TDF) use.

Study design : This research follows a research and development (R&D) design.

Materials and Methods : The study was divided into four phases. Phase 1 involved examining the incidence of kidney toxicity in HIV patients receiving TDF treatment from October 2021 to March 2024, with data collected through structured questionnaires and a TDF kidney toxicity management and monitoring model that includes a dosage adjustment table. In Phase 2, the management and monitoring model for TDF-induced kidney toxicity was developed. Phase 3 focused on implementing the model, and Phase 4 assessed its outcomes between April and September 2024. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation, and inferential statistics with McNemar's test.

Main findings : In the fiscal year 2022, three cases of kidney toxicity (categorized as drug-related problems [DRPs] with severity level C) were observed. In 2023, the number increased to four cases, with one at severity level D and three at level E. By fiscal year 2024 (October 2023 - March 2024), five cases were identified, with two at level C, two at level D, and one at level E, suggesting an upward trend in incidence. A multidisciplinary team collaborated to develop a five-step TDF kidney toxicity management and monitoring model, comprising (1) eGFR assessment, (2) physician consultation, (3) dosage adjustment per table, (4) follow-up within 2-4 weeks, and (5) pharmaceutical care. Post-implementation, medication error-related issues decreased from 11.6% to 3.7% (p<.05), and no severe kidney complications were reported. Both healthcare providers and patients reported high overall satisfaction with the model (Mean=4.51 for providers and 4.26 for patients).

Conclusions and Recommendations : The developed model proves beneficial for multidisciplinary teams, enhancing efficiency and safety in patient care. Continuous model review, along with regular updates to data and tools, will facilitate the prevention and monitoring of medication-related problems, enabling timely treatment adjustments and the normalization of renal function.