J Viral Hepat. 2019 Oct 22. doi: 10.1111/jvh.13222. [Epub ahead of print]
An observational study on long-term renal outcome in patients with chronic hepatitis B treated with tenofovir disoproxil fumarate.
Lim TS1,2,3, Lee JS1,2, Kim BK1,2, Lee HW1,2, Jeon MY1,2, Kim SU1,2, Park JY1,2, Kim DY1,2, Han KH1,2, Ahn SH1,2.
Author information
1
Department of Internal Medicine, Yonsei University, College of Medicine, Republic of Korea.
2
Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
3
Division of Gastroenterology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea.
Abstract
In patients with chronic hepatitis B (CHB), long-term effects of tenofovir disoproxil fumarate (TDF) on renal function have been controversial. This study aimed to analyze the real-world long-term effects of TDF on renal function in Korean patients with CHB. We analyzed a cohort of 640 treatment-naïve patients with CHB who were treated with TDF between May 2012 and December 2015 at Severance Hospital, Seoul, Republic of Korea. The mean age was 48.3 years old, and 59.5% were male. The proportions of hypertension and diabetes mellitus (DM) were 11.6% and 14.2%, respectively, and that of liver cirrhosis was 20.8%. During the 5 year follow up, using a linear mixed model, serum creatinine increased from 0.77 ± 0.01 mg/dL to 0.85 ± 0.02 mg/dL (P<0.001), and eGFR decreased from 102.6 ± 0.6 mL/min/1.73m2 to 93.4 ± 1.4 mL/min/1.73m2 (P<0.001). In subgroup analysis, eGFR was statistically more decreased in patients with age >60 than ≦60 years old (P=0.027), and in patients with diuretic use than without diuretic use (P=0.008). In multivariate analysis, the independent risk factors for eGFR decrease >20% were baseline eGFR <60mL/min/1.73m2 (P=0.034) and the use of diuretics (P<0.001). CHB patients on TDF experienced greater reduction in renal function with age >60 and with diuretic use compared to those without these characteristics. Baseline eGFR <60mL/min/1.73m2 and use of diuretics were independent risk factors of eGFR decline of more than 20% on TDF therapy.