慢性乙型肝炎患者在替诺福韦，恩替卡韦或未治疗的慢性肾

StephenW

Aliment Pharmacol Ther. 2018 Aug 20. doi: 10.1111/apt.14945. [Epub ahead of print]
Chronic kidney disease progression in patients with chronic hepatitis B on tenofovir, entecavir, or no treatment.
Wong GL1,2,3, Chan HL1,2,3, Tse YK1,2, Yip TC1,2, Lam KL1,2, Lui GC1, Szeto CC2,4, Wong VW1,2,3.
Author information
Abstract
BACKGROUND:

In clinical trials involving patients with preserved renal function, tenofovir disoproxil fumarate (TDF) use was associated with mild renal impairment in 1% of patients.
AIM:

To compare serial renal function of entecavir (ETV)-treated, TDF-treated, and untreated patients with chronic hepatitis B.
METHODS:

We studied the risk of chronic kidney disease (CKD) progression in a territory-wide cohort of patients with chronic hepatitis B without treatment and of those on ETV or TDF treatment. Estimated glomerular filtration rate (eGFR) was determined by the CKD Epidemiology Collaboration equation and was classified into five CKD stages. CKD progression, defined as an increase of at least one CKD stage, was compared among treated and untreated patients.
RESULTS:

After propensity score matching, 2254 ETV-treated, 2254 TDF-treated, and 2254 untreated patients were included in the analysis. Their mean baseline eGFR was 90.3 ± 19.6, 91.3 ± 20.6, and 92.2 ± 20.0 mL/min/1.73 m2 , respectively. During a mean follow-up of 2.4 ± 1.5 years, 639 ETV-treated, 706 TDF-treated, and 564 untreated patients exhibited CKD progression ≥1 stage. The 5-year cumulative incidence (95% confidence interval) of CKD progression was 43% (40%-46%) in ETV-treated, 48% (45%-51%) in TDF-treated, and 43% (39%-47%) in untreated patients (reference group), respectively (P = 0.267 and <0.001, respectively). The number of patients who exhibited CKD progression ≥2 stages was 92 (4.1%) in the untreated cohort, 95 (4.2%) in the ETV-treated cohort, and 51 (2.3%) in the TDF-treated cohort.
CONCLUSIONS:

The use of TDF was associated with mild renal impairment in a minority of patients; those treated with ETV had a similar risk compared to untreated patients.

© 2018 John Wiley & Sons Ltd.

PMID:
    30125952
DOI:
    10.1111/apt.14945

StephenW

Aliment Pharmacol Ther。 2018年8月20日.doi：10.1111 / apt.14945。 [提前打印]
慢性乙型肝炎患者在替诺福韦，恩替卡韦或未治疗的慢性肾病进展。
Wong GL1,2,3，Chan HL1,2,3，Tse YK1,2，Yip TC1,2，Lam KL1,2，Lui GC1，Szeto CC2,4，Wong VW1,2,3。
作者信息
抽象
背景：

在涉及肾功能保留患者的临床试验中，1％的患者使用替诺福韦地索普西富马酸盐（TDF）与轻度肾功能损害相关。
目标：

比较恩替卡韦（ETV）治疗，TDF治疗和未治疗慢性乙型肝炎患者的系列肾功能。
方法：

我们研究了未经治疗的全区慢性乙型肝炎患者和ETV或TDF治疗患者的慢性肾病（CKD）进展风险。估计的肾小球滤过率（eGFR）由CKD流行病学协作方程确定，并分为五个CKD阶段。在治疗和未治疗的患者中比较CKD进展，定义为至少一个CKD阶段的增加。
结果：

在倾向评分匹配后，分析中包括2254个ETV治疗的，2254个TDF治疗的和2254个未治疗的患者。它们的平均基线eGFR分别为90.3±19.6,91.3±20.6和92.2±20.0 mL / min / 1.73 m2。在平均随访2.4±1。5年期间，639例ETV治疗，706例TDF治疗和564例未治疗患者的CKD进展≥1期。 CKD进展的5年累积发生率（95％置信区间）在ETV治疗中为43％（40％-46％），在TDF治疗中为48％（45％-51％），43％（39％）未治疗患者（参考组）分别为-47％（分别为P = 0.267和<0.001）。 CKD进展≥2个阶段的患者数在未治疗组中为92（4.1％），在ETV治疗组中为95（4.2％），在TDF治疗组中为51（2.3％）。
结论：

TDF的使用与少数患者的轻度肾功能损害有关;与未治疗的患者相比，接受ETV治疗的患者具有相似的风险。

©2018 John Wiley＆Sons Ltd.

结论：
    30125952
DOI：
    10.1111 / apt.14945