两种替诺福韦减量方案（每48小时300 mg与每72小时300 mg）在慢

StephenW

Comparison of viral control between two tenofovir dose reduction regimens (300 mg every 48 hours versus 300 mg every 72 hours) in chronic hepatitis B patients with moderate renal impairment from tenofovir-induced renal dysfunction
Watcharasak Chotiyaputta  1 , Karn Poosanasuwansri  1 , Kraiwiporn Kiattisunthorn  2 , Siwaporn Chainuvati  1 , Tawesak Tanwandee  1
Affiliations
Affiliations

    1
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    2
    Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

    PMID: 33047455 DOI: 10.1111/jvh.13420

Abstract

Long-term use of tenofovir disoproxil fumarate (TDF) can induce renal dysfunction that requires TDF dose reduction. Previous studies showed that systemic drug use exerts a 3-fold higher risk of moderate renal impairment. This study aimed to compare viral control between two tenofovir dose reduction regimens in chronic hepatitis B (CHB) patients with moderate renal impairment from TDF-induced renal dysfunction.This non-inferiority, randomized controlled study was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Virologically-suppressed CHB patients treated with TDF who had moderate renal impairment were randomly allocated to receive TDF 300 mg either every 48 or 72 hours. Forty-six patients (67.4% male) with a mean age of 62.8±7.8 years were enrolled. Among all patients, 34.8% were HBeAg positive, and 23.9% had cirrhosis. All included patients completed 12 months of follow-up. No patients had virological breakthrough. After dose reduction, estimated glomerular filtration rate (eGFR) was improved in both groups, but a higher proportion of patients had an eGFR >60 mL/min/1.73m2 in the TDF every 72 hours group. Other renal parameters, including serum phosphate, tubular maximal reabsorption for phosphate per GFR, urine protein to creatinine ratio, urine sugar, and urine neutrophil gelatinase-associated lipocalin, were not significantly different between groups. Among TDF-treated CHB patients with TDF-induced moderate renal impairment, more aggressive dose reduction of TDF from every 48 hours to every 72 hours did not affect virological breakthrough. A higher proportion of patients in the TDF every 72 hours group had improvement in renal function.

Keywords: chronic hepatitis B patients; moderate renal impairment; tenofovir dose reduction regimens; tenofovir-induced renal dysfunction; viral control.

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StephenW

两种替诺福韦减量方案（每48小时300 mg与每72小时300 mg）在慢性乙型肝炎中由替诺福韦引起的肾功能不全的中度肾功能不全患者中病毒控制的比较
Watcharasak Chotiyaputta 1，Karn Poosanasuwansri 1，Kraiwiporn Kiattisunthorn 2，Siwaporn Chainuvati 1，Tawesak Tanwandee 1
隶属关系
隶属关系

    1个
    泰国曼谷玛希顿大学医学院Siriraj医院医学系消化内科。
    2
    泰国曼谷玛希顿大学西里拉吉医院医学院内科肾病科。

    PMID：33047455 DOI：10.1111 / jvh.13420

抽象

长期使用替诺福韦富马酸替索罗非酯（TDF）可以诱发肾功能不全，需要减少TDF剂量。先前的研究表明，全身性药物使用会导致中度肾功能不全的风险增加3倍。这项研究旨在比较TDF诱发的肾功能不全的中度肾功能不全的慢性乙型肝炎（CHB）患者在两种替诺福韦减量方案之间的病毒控制效果。玛希顿大学，泰国曼谷。经病毒学抑制的TDF治疗的中度肾功能不全的CHB患者每48或72小时随机分配一次，接受300 mg TDF。纳入平均年龄为62.8±7.8岁的46例患者（男性占67.4％）。在所有患者中，HBeAg阳性率为34.8％，肝硬化为23.9％。所有纳入的患者均完成了12个月的随访。没有患者有病毒学突破。降低剂量后，两组的估计肾小球滤过率（eGFR）均得到改善，但每72小时TDF中eGFR> 60 mL / min / 1.73m2的患者比例更高。两组之间的其他肾脏参数，包括血清磷酸盐，肾小管对每GFR的最大磷酸盐重吸收，尿蛋白与肌酐的比值，尿糖和与中性粒细胞明胶酶相关的脂质钙蛋白无显着差异。在由TDF治疗的患有TDF引起的中度肾功能不全的CHB患者中，更积极地将TDF剂量从每48小时减少到每72小时不影响病毒学突破。每72小时的TDF组中有较高比例的患者肾功能得到改善。

关键词：慢性乙型肝炎患者中度肾功能不全；替诺福韦减量方案；替诺福韦引起的肾功能不全；病毒控制。

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乙肝人1949