Preventing kidney toxicity

The risk of kidney stones can be reduced by consuming adequate fluids, which helps maintain drugs in solution. People taking indinavir (Crixivan) and other drugs associated with kidney stones are advised to drink 1.5 litres of water every day.

Patients with severe kidney disease should avoid tenofovir (Viread). According to the drug’s manufacturer, Gilead Sciences, patients with creatinine clearance rates below 50 ml/min must have their tenofovir dosing interval increased, since it takes longer for their kidneys to eliminate the drug. The fixed-dose combination tablet Truvada should not be used if creatinine clearance is below 30 ml/min, since the tenofovir dosing interval cannot be appropriately adjusted without also changing the dose of FTC (emtricitabine, Emtriva).

People with pre-existing kidney dysfunction should also receive lower doses of nucleoside reverse transcriptase inhibitors, except for abacavir (Ziagen).1

References

  1. Gupta SK et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 40: 1559-1585, 2005