Changes in Renal Function in Patients With Chronic HBV infection Treated with Tenofovir Disoproxil Fumarate vs Entecavir
Sam Trinh
, An K. Le
, Ellen T. Chang
, Joseph Hoang
, Donghak Jeong
, Mimi Chung
, Mei-Hsuan Lee
, Uerica Wang
, Linda Henry
, Ramsey Cheung
, Mindie H. Nguyen'Correspondence information about the author Mindie H. NguyenEmail the author Mindie H. Nguyen
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Abstract
Abstract
Background & Aims
It is unclear whether drugs used to treat chronic hepatitis B virus (HBV) infection cause significant renal impairment. We compare adjusted mean estimated glomerular filtration rates (eGFR; mL/min/1.73 m2) of patients with chronic HBV infection treated with tenofovir disoproxil fumarate (TDF) vs patients treated with entecavir.
Methods
We performed a retrospective study of patients with chronic HBV infections treated with TDF (n=239) or entecavir (n=171), from 2000 through 2016, followed for a mean time of 43–46 months. Levels of serum creatinine were measured ≥12 months while patients received treatment. Patients did not have prior exposure to adefovir or HCV, HDV, or HIV co-infection. We performed propensity score matching (PSM) for age, sex, presence of hypertension, diabetes mellitus, baseline eGFR, cirrhosis, and follow-up duration. We performed multivariate generalized linear modeling, adjusting for cirrhosis, diabetes, and hypertension, to estimate adjusted mean eGFR for matched and unmatched cohorts. Cox regression was used to identify predictors of renal impairment
Results
eGFRs were ≥60, after PSM, in 116 patients given entecavir and in 116 patients given TDF; eGFRs were <60 in 32 patients given entecavir and 26 patients given TDF. Multivariate generalized linear modeling of the unmatched overall and <60 eGFR cohorts revealed significantly lower adjusted mean eGFRs in patients given TDF (all P<.001). However, in the eGFR ≥60 PSM cohort, the adjusted mean eGFR was similar between patients receiving either treatment. In Cox regression analysis, TDF was not associated with mild or moderate renal impairment compared with entecavir.
Conclusion
In a retrospective study of patients with chronic HBV infections treated with TDF vs entecavir, we found that TDF was not associated with higher risk of worsening renal function during short- or intermediate-term follow-up periods, among patients without significant renal impairment. Additional studies, with longer follow-up periods, are needed because treatment for chronic HBV infection is generally long term or life-long. For patients with baseline renal impairment, significant renal decline was among patients given TDF compared to patients given entecavir.
Key Words:
kidney function, side effect, complication, HBV therapy
Abbreviations:
TDF (tenofovir disoproxil fumarate), eGFR (estimated glomerular filtration rate), CHB (chronic hepatitis B), ETV (entecavir), PSM (propensity score matching), HBV (hepatitis B virus), TAF (tenofovir alafenamide), GLM (generalized linear models), HRs (hazard ratios), CIs (confidence intervals)作者: StephenW 时间: 2018-8-22 18:08
替诺福韦地索普西富马酸钠与恩替卡韦治疗慢性HBV感染患者肾功能的变化
Sam Trinh
，An K. Le
，Ellen T. Chang
，约瑟夫·霍恩
，Donghak Jeong
，Mimi Chung
，李梅轩
，Uerica Wang
琳达亨利
，Ramsey Cheung
，Mindie H. Nguyen'关于作者的相关信息Mindie H. Nguyen给作者Mindie H. Nguyen发邮件
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抽象
抽象
背景与目的
尚不清楚用于治疗慢性乙型肝炎病毒（HBV）感染的药物是否会导致严重的肾功能损害。我们比较了使用替诺福韦地索普西富马酸盐（TDF）治疗的慢性HBV感染患者与恩替卡韦治疗患者的调整后平均估计肾小球滤过率（eGFR; mL / min / 1.73 m2）。
方法