EASL 2018 FRI-331
Treatment of chronic hepatitis B and renal impairment in patients
with and without cirrhosis
V. Vu, S. Trinh,A. Le, T. Johnson, J. Hoang, D. Jeong, L. Henry,M. Nguyen.
Stanford University Medical Center, Division of Gastroenterology and
Hepatology
Email: [email protected]
Background and Aims: Recent studies have shown that renal
impairment in chronic hepatitis B (CHB) patients may result from
treatment with oral nucleos(t)ide analogue medications. However,
treatment with entecavir (ETV) has been associated with less renal
toxicity, though data on this is limited. It is also unclear whether ETV
therapy is more associated with development of poorer renal
function compared to untreated CHB patients. The study aim was to
determine renal outcomes among CHB patients who are untreated
and treated with ETV with and without cirrhosis over time.
Method: Patients infected with CHB who were untreated or treated
with ETV were recruited from a retrospective cohort of consecutive
adult patients at a U.S. tertiary center between 1996 and 2017.
Patients were not recruited if coinfected with hepatitis D, hepatitis C,
or human immunodeficiency virus, or had prior history of treatment
with adefovir or tenofovir. Patients were included if they had =>12
months of serial creatinine labs and baseline estimated glomerular
filtration rate (eGFR, calculated using the Modification of Diet in Renal
Disease Study equation) =>60ml/min/1.73 m2 (n = 522). Propensity
score matching (PSM) for age, sex, race, diabetes (DM), hypertension
(HTN), and baseline eGFR was performed to compare untreated
patients versus ETV-treated patients without cirrhosis (non-cirrhotic
cohort) and with cirrhosis (cirrhotic cohort). Generalized linear
regression modeling (GLM) controlling for sex, race, DM, and HTN
was performed to generate mean eGFR over time.
Results: The non-cirrhotic cohort (n = 314) had a mean age of 48 ± 12
years. Most were male (58%) and Asian (91%). Twenty patients had
DM (6%) and 74 had HTN (24%). Patients had a median eGFR of 85.1
(IQR = 61.5–139.6) and median follow-up of 70 months (IQR = 12–
199). The cirrhotic cohort (n = 150) had a mean age of 55 ± 12 years.
The majority were male (73%) and Asian (89%), with 27% having
DM and 51% having HTN. Median eGFR was 79.1 (IQR = 61.0–118.4)
and median follow-up was 69 months (IQR = 13–166). On GLM for
the non-cirrhotic cohort, there was a significant difference in the
eGFR between untreated patients and ETV-treated patients (85.1 vs.
83.5, p = 0.02). For the cirrhotic cohort, GLM showed no significant
difference in the eGFR of untreated patients and ETV-treated patients
(76.2 vs. 76.0, p = 0.80) (Figure).
Conclusion: In this PSM study comparing untreated patients and
ETV-treated patients with and without cirrhosis, no significant
differences in renal function was noted for the cirrhotic group.
Mean eGFRwas slightly lower in ETV-treated patients than untreated
non-cirrhotic patients, but remained at or close to normal range in
both groups at 5-year follow-up. These findings suggest that ETV
treatment does not have major influence on renal function of CHB
patients; but since CHB therapy is often long-term, further studies
with longer follow-up is needed.