低磷酸盐血症预测在拉米夫定耐药性乙型肝炎患者剂量减少

StephenW

Hepatol Res. 2017 Jan 12. doi: 10.1111/hepr.12865. [Epub ahead of print]
Hypophosphatemia predicts a failure to recover from adefovir-related renal injury after dose reduction in lamivudine-resistant hepatitis B patients.Yamamoto T1, Maruyama Y2, Ohashi N3, Yasuda H3, Shinozaki M4.
Author information

• 1Department of Nephrology, Fujieda Municipal General Hospital, Fujieda, Japan.
• 2Department of Gastroenterology, Fujieda Municipal General Hospital, Fujieda, Japan.
• 3First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
• 4Department of Gastroenterology, Numazu City Hospital, Numazu, Japan.
  

AbstractAIM: In chronic hepatitis B patients receiving 10 mg adefovir, dose reduction is recommended when renal injury appears. However, recovery is not always achieved and markers that recommend switching to another antiviral agent are unknown. We investigated adefovir-related renal injury, recovery after dose reduction, and their predictors.
METHODS: The renal injury in 77 chronic hepatitis B patients receiving 10 mg adefovir and recovery after dose reduction to alternate day administration in those with adefovir-related renal injury were assessed. The predictors for >20% estimated glomerular filtration rate (eGFR) decline following 10 mg adefovir administration and for >20% eGFR recovery after dose reduction were investigated.
RESULTS: The adefovir dose was reduced in 26 patients (34%) at 59 ± 30 (mean ± SD) months of 10 mg adefovir administration because of decreases in eGFR (cumulative incidence 27%), serum phosphorus (9%) and uric acid (16%) levels, and increases in alkaline phosphatase (20%), bone type alkaline phosphatase (18%), urinary α1-microglobulin (18%) and urinary N-acetyl-β-D-glucosaminidase (18%) levels. ≥50 years of age at the start of 10 mg adefovir administration was the only significant predictor for >20% eGFR decline. The cumulative eGFR recovery rate was 42% at 42 ± 27 months after dose reduction, and ≥2.5 mg/dL of serum phosphorus level at dose reduction was the only significant predictor for >20% eGFR recovery after dose reduction.
CONCLUSION: The patients ≥50 years of age are predisposed to adefovir-related renal injury and switching to another antiviral agent rather than adefovir dose reduction is recommended when hypophosphatemia is observed.

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KEYWORDS: adefovir; eGFR; hepatitis B; hypophosphatemia; osteomalacia; renal injury

PMID:28079295DOI:10.1111/hepr.12865

StephenW

Hepatol Res。 2017年1月12日。doi：10.1111 / hepr.12865。 [打印前的电子版]
低磷酸盐血症预测在拉米夫定耐药性乙型肝炎患者剂量减少后从阿德福韦相关肾损伤中恢复的失败。
Yamamoto T1，Maruyama Y2，Ohashi N3，Yasuda H3，Shinozaki M4。
作者信息

    1，肾脏病学，藤枝市立总医院，藤枝，日本。
    日本藤枝市藤田市总医院消化内科。
    3滨松大学医学部第一医学部，滨松，日本。
    4日本沼津市医院消化内科。

抽象
目标：

在接受10毫克阿德福韦的慢性乙型肝炎患者中，当出现肾损伤时推荐减少剂量。然而，恢复并不总是实现，建议切换到另一种抗病毒药物的标记是未知的。我们调查阿德福韦相关肾损伤，剂量减少后恢复，及其预测因子。
方法：

在接受10毫克阿德福韦的77名慢性乙型肝炎患者中的肾损伤和在与阿德福韦相关肾损伤的那些患者中的剂量减少至交替日施用后的恢复。研究了10mg阿德福韦给药后> 20％估计肾小球滤过率（eGFR）下降和剂量减少后> 20％eGFR恢复的预测因子。
结果：

由于eGFR（累积发生率27％），血清磷（9％）和尿酸（16％）的降低，阿德福韦剂量在10mg阿德福韦给药的59±30（平均值±SD） ％）水平，碱性磷酸酶（20％），骨髓型碱性磷酸酶（18％），尿α1-微球蛋白（18％）和尿N-乙酰-β-D-氨基葡萄糖苷酶（18％）水平增加。在阿德福韦10mg给药开始时≥50岁是≥20％eGFR下降的唯一重要预测因子。在剂量减少后42±27个月，累积eGFR恢复率为42％，在剂量减少后≥2.5mg/ dL的血清磷水平是剂量减少后≥20％eGFR恢复的唯一重要预测因子。
结论：

≥50岁的患者倾向于阿德福韦相关的肾损伤，并且当观察到低磷血症时，推荐切换到另一种抗病毒药物而不是阿德福韦剂量减少。

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关键词：

阿德福韦eGFR;乙型肝炎;低磷血症;骨软化;肾损伤

PMID：
    28079295
DOI：
    10.1111 / hepr.12865