替诺福韦取得进展对抗治疗引起的肾毒性在HBV相关的慢性肝

StephenW

Tenofovir stems treatment-induced kidney toxicity in HBV-related chronic hepatitis
Published on January 28, 2015 at 5:15 PM · No Comments



By Lucy Piper, Senior medwireNews Reporter

Switching to tenofovir may stave further kidney and bone impairment in patients with hepatitis B virus-related chronic hepatitis taking adefovir-based therapy, retrospective study findings suggest.

But until prospective studies have been carried out to confirm their findings, the study researchers recommend clinicians monitor markers of kidney and bone toxicity in patients receiving tenofovir, especially following a switch from adefovir-based therapy, and pay particular attention to baseline values.

Lead researcher Paolo Maggi (Policlinico-University of Bari, Italy) and colleagues found a high prevalence of kidney and bone impairment in 60 patients who had taken lamivudine monotherapy followed by lamivudine plus adefovir for up to a mean of 114 months.

The average estimated glomerular filtration rate (eGFR) was 89.3 mL/min per 1.73 m2 and 40% and 6.7% of patients had levels below 90 mL/min per 1.73 m2 (representing chronic kidney disease [CKD] stage II) and 60 mL/min per 1.73 m2 (CKD stage III), respectively. This compares with corresponding rates in the general population of 3.0% and 4.6%.

A total of 18.6% of patients had hypophosphataemia (<2.5 mg/dL), 26.9% had proteinuria (>200 mg/24 hours), 22.6% tested positive for microscopic haematuria and 29.6% had hyperparathyroidism (>65 pg/mL).

Also, suboptimal plasma levels of vitamin D (11–29 ng/mL) were present in 92.6% of the patients and more than half of the patients had reduced bone mineral density (BMD).

Switching to tenofovir monotherapy provoked a moderate decline in eGFR, which stabilised after 6 months showing no further progression at months 9 and 12. After 1-year of tenofovir treatment, the average eGFR was 82.6 mL/min per 1.73 m2, reflecting a reduction of 7.5%. About half of the patients progressed from CKD stage I to II or from stage II to III, the team reports in the Journal of Antimicrobial Chemotherapy.


There was a worsening of serum phosphate and parathyroid hormone levels, haemoglobinuria and 24-hour proteinuria after 1 month of tenofovir treatment, but after 3 and 12 months levels of all these parameters had recovered to baseline levels.

“Although exposure to tenofovir has been associated with phosphate wasting and hypophosphataemia, we did not observe a worsening of the prevalence and magnitude of hypophosphataemia in the present study”, the researchers comment.

Vitamin D levels improved with tenofovir treatment and supplementation for those with hypovitaminosis D, with the percentage of patients with normal plasma levels increasing from about 7% to 30%.

The proportion of patients with reduced BMD increased to 77.8% after 6 months of tenofovir, but at 1 year the percentage had fallen to a level slightly above the baseline value. This transient effect of tenofovir on BMD was “perhaps in line with the relatively preserved phosphate and vitamin D homeostasis”, Maggi et al suggest.

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StephenW

替诺福韦取得进展对抗治疗引起的肾毒性在HBV相关的慢性肝炎
发表于2015年1月28日在5:15 PM·没有评论



由露西·派珀，高级medwireNews记者

切换到泰诺福韦可能延缓肾功能进一步和骨损伤患者乙肝病毒相关的慢性肝炎服用阿德福韦为基础的治疗，回顾性研究结果提示。

但直到前瞻性研究已经进行了确认他们的研究结果，该研究的研究人员建议医生监测肾在接受替诺福韦，尤其是下面的阿德福韦酯为基础的治疗交换机患者骨毒性指标，并特别注意基线值。

首席研究员保罗·马吉和他的同事（巴里，意大利位于Policlinico-大学）谁采取拉米夫定单药治疗后拉米夫定加阿德福韦长达平均114个月的60例患者发现肾脏和骨骼损伤的发病率较高。

平均估计肾小球滤过率（eGFR）为89.3毫升/分钟每1.73平方米，40％和6.7％的患者有每1.73平方米（相当于慢性肾脏疾病[CKD]Ⅱ期）和60毫升低于90毫升/分钟的水平/分每1.73平方米（CKD阶段III），分别为。与此相比，相应的利率在3.0％和4.6％的总人口。

共有患者18.6％的低磷酸盐血症（<2.5毫克/分升），26.9％有蛋白尿（>200毫克/24小时），22.6％呈阳性镜下血尿和29.6％有甲状旁腺功能亢进症（>65皮克/毫升）。

此外，维生素D（11-29毫微克/毫升）次优的血浆水平存在于患者92.6％和超过一半的患者具有降低骨矿物质密度（BMD）。

切换到单用替诺福韦引起了温和下降，EGFR，6个月后显示出12。没有进一步的进展，在9个月后和替诺福韦治疗1年其稳定，平均的eGFR为每1.73平方米82.6毫升/分钟，反映出减少7.5％。大约有一半的患者进展，从CKD阶段，我要II或II期到III，在抗菌化学疗法杂志上报告。


有一个不断恶化的血磷和甲状旁腺激素水平，血红蛋白尿和24小时尿蛋白1个月替诺福韦治疗后，但在3至12个月的水平所有这些参数已经恢复到基线水平。

“虽然接触替诺福韦已与磷酸浪费和低磷酸盐血症有关，我们没有观察到恶化的患病率和低磷酸盐血症在本研究中量级”，研究人员发表评论。

维生素D水平改善了与替诺福韦治疗和补充对于那些与维生素D缺乏，与正常的患者血浆水平从约7％上升到30％的百分比。

的患者具有降低的骨密度的比例增加至77.8％6个月替诺福韦之后，但在第1年的比例已下降到一定水平略高于基线值。替诺福韦对BMD的这种瞬态效应是“或许与相对保存磷酸盐和维生素D稳态线”，美极等建议。

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重韧

想说明什么，轻微肾毒性吗？

StephenW

回复 重韧 的帖子

在拉米夫定单药治疗, 后拉米夫定加阿德福韦长达平均114个月的60例患者,发现较高肾脏和骨骼损伤发病率.转换到单用替诺福韦, 可延缓进一步肾脏和骨骼损伤.

重韧

回复 StephenW 的帖子

只能说明替诺比阿德好一些，但也只是延缓。。。说明还是损伤。