EDCTP Alumni Network

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Call Career Development Fellowship (CDF)
Programme EDCTP2
Start Date 2017-05-01
End Date 2019-04-30
Project Code TMA2015CDF1002
Status Active


Proximal tubular renal dysfunction among HIV patients on Tenofovoir versus Tenofovir sparing regimen


To assess proximal tubular renal dysfunction among HIV infected patients on TDF regimen compared to those on TDF sparing regimen

Host Organisation

Institution Country
Moi University Kenya

Study Design

This was a cross sectional design comparing outcomes (proximal tubular renal dysfunction and global renal function) in TDF (exposed) and TDF-sparing (unexposed) groups at the same point in time.

Current Organisation

Moi University

Current Job Title

Assistant Lecturer


2019 MRCP 1 and 2 (Written)

Students Supervised

Type Name Title University Start Date End Date


Role Committee/board Start Date End Date


Institution Degree Year
University of Nairobi, Kenya MBChB 2010-12-03
London School of hygiene and Tropical medicine, United Kingdom MSc Epidemiology 2016-03-10
Moi University, Kenya MMED Internal Medicine 2019-12-20

Areas Of Specialisation

Human Immuno-deficiency Virus (HIV)



Mercy Jelagat Karoney, Mathew Kirtptonui Koech, Evangeline Wawira Njiru, Willis Dixon Owino Ong’or , Karoney MJ, Koech MK, Njiru EW, Owino Ong’or WD (2022) Proximal tubular renal dysfunction among HIV infected patients on Tenofovir versus Tenofovir sparing regimen in western Kenya. PLoS ONE 17(9): e0273183. doi:10.1371/journal.pone.0273183


Tenofovir Disoproxil Fumarate (TDF) is the most widely used Anti-Retroviral Therapy (ART) drug due to its potency, safety profile and World Health Organization (WHO) recommendation. TDF causes proximal tubular renal dysfunction (PTRD) leading to Fanconi syndrome, acute kidney injury and chronic kidney disease. Modest rates (2–4%) of TDF related toxicity based on estimated Glomerular Filtration Rate (GFR) have been described, while TDF-induced PTRD has been reported to be 22%. TDF toxicity is more likely among African patients, it is reversible and TDF may be renal dosed in patients with dysfunction. The objective of this study was to assess proximal tubular renal dysfunction, global renal function, and their determinants among patients on TDF versus TDF-sparing regimen.


This was a cross-sectional study among people living with HIV/AIDS (PLWHA) attending the Academic Model Providing Access to Healthcare (AMPATH) program. The primary outcome of interest in this study was PTRD while the secondary outcome of interest was estimated GFR. PTRD was defined as any two of beta-2 microglobulin in urine, metabolic acidosis, normoglycemic glucosuria and fractional excretion of phosphate. Student’s t-test, chi-square and their non-parametric equivalents were used to test for statistical significance. Univariate and multivariate logistic regression analysis was carried out.


A total of 516 participants were included in the final analysis, 261 on TDF while 255 were on TDF-sparing regimens. The mean (SD) age of all participants was 41.5 (12.6) years with majority being female (60.3%). The proportion of PTRD was 10.0% versus 3.1% in the TDF compared to TDF-sparing group (P<0.001). Mean estimated GFR was 112.8 (21.5) vs 109.7 (21.9) ml/min/1.73mm3 (P = 0.20) for the TDF compared to TDF-sparing group. TDF users were more likely to have PTRD compared to non-TDF users, adjusted Odds Ratio (AOR) 3.0, 95% CI 1.12 to 7.75.


There was significant PTRD in the TDF compared to TDF-sparing group without significant difference in estimated GFR. The clinical significance of these findings may not be clear in the short term.


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