Tenofovir disoproxil fumarate (TDF)-containing pre-exposure prophylaxis (PrEP) was associated with a low risk of renal impairment overall in patients at high risk of HIV infection, while older patients and those with pre-existing renal dysfunction were at substantially increased risk, according to a study published in AIDS. Investi- gators conducted a post-hoc analysis of EPIC- NSW, a large, multicenter PrEP implementation trial. Participants were eligible for inclusion if they commenced PrEP between March 1, 2016 and April 30, 2018 and had renal function as- sessed at baseline and at least once more before the censor date. The primary outcome was new onset renal impairment, defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73m2. A total of 6,808 participants were eligible for inclusion. Almost all were male (99%), with a median age of 35 years. Approxi- mately one-quarter (26%) had a baseline eGFR less than 90 mL/min/1.73m2. During a median follow-up period of 1.2 years, the rate of renal impairment was 5.8 episodes per 1,000 person years (95% CI, 4.0-7.8). In multivariable Cox regression, there was higher risk of renal im- pairment in participants aged 50 years or more (HR, 14.7; 95% CI, 5.0-43.3) and those with an eGFR less than 90 mL/min/1.73m2 (HR, 28.9; 95% CI, 6.9-121.9) at baseline.