慢性乙型肝炎患者從長期其他核苷酸類似物治療轉換後，替

StephenW

慢性乙型肝炎患者從長期其他核苷酸類似物治療轉換後，替諾福韋艾拉酚胺兩年的腎臟安全性和生化變化
Tetsuya Hosaka 1 , Fumitaka Suzuki 1 , Masahiro Kobayashi 1 , Shunichirou Fujiyama 1 , Yusuke Kawamura 1 , Hitomi Sezaki 1 , Norio Akuta 1 , Yoshiyuki Suzuki 1 , Satoshi Saitoh 1 , Kobayashi Kobayashi 1 , Kosuji Arasea Marase 2 1 1
隸屬關係
隸屬關係

    1
    肝病科和。
    2
    日本東京虎之門醫院肝病研究所。

    PMID：34687121 DOI：10.1111/hepr.13726

抽象的

背景：長期使用核苷酸類似物如阿德福韋 (ADV) 或富馬酸替諾福韋酯 (TDF) 可能會導致腎功能損害。替諾福韋艾拉酚胺 (TAF) 的全身暴露量低於 TDF。研究從長期 ADV 和 TDF 轉換為 TAF 兩年後腎功能和生化參數的縱向變化，並探討慢性乙型肝炎 (CHB) 患者 TAF 後腎功能改善的相關因素。

方法：前瞻性觀察隊列研究包括 306 名 CHB 患者，這些患者從長期 TDF 或 ADV 轉換為 TAF。主要結果是 TAF 後估計腎小球濾過率 (eGFR) 的變化。

結果：在 306 名患者中，190 名 (65.3%) 和 106 名 (34.7%) 在基線時患有慢性腎病 (CKD) 1-2 和 3a-4 期。在 CKD 3a-4 期患者中，平均 eGFR 顯著增加直到第 12 週，並從第 12 周到第 2 年趨於平穩（使用線性混合效應模型調整斜率：+9.01 ml/min/1.73 m2/年，直到第 12 週；P < 0.001）。相比之下，CKD 1-2 期亞組的平均 eGFR 從基線到第 2 年趨於平穩。多變量邏輯回歸顯示，基線 CKD 分期 ≥ 3a、TAF 前 1 年 eGFR 下降幅度更大以及使用任何核苷酸類似物的持續時間較短與第 1 年 eGFR 改善 ≥ 10% 顯著相關。

結論：從 TDF 或 ADV 轉換為 TAF 可在 2 年內獲得良好的腎臟安全性。在 CKD 3a-4 期亞組中，TAF 後的 eGFR 在前 12 週內恢復並隨後穩定。本文受版權保護。版權所有。

關鍵詞：ADV； ALT;體重指數；慢性腎病；教育電視；乙肝病毒； HBeAg;肝細胞癌；我是;或者;鵬; TAF; TDF; TRP；替諾福韋艾拉酚胺； U-ACR； U-β2MG/Cr；阿德福韋酯；丙氨酸氨基轉移酶；體重指數；慢性腎病; eGFR；恩替卡韋；估計的腎小球濾過率；乙型肝炎e抗原；乙型肝炎病毒;肝細胞癌;拉米夫定;優勢比；受試者工作特徵曲線；鉻；血清肌酐;替諾福韋艾拉酚胺；富馬酸替諾福韋二吡呋酯；磷酸鹽的腎小管重吸收；尿白蛋白肌酐比值；尿β2-微球蛋白肌酐比值。

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StephenW

Renal safety and biochemical changes for two years of tenofovir alafenamide after switching from long-term other nucleotide analogues treatment in patients with chronic hepatitis B
Tetsuya Hosaka  1 , Fumitaka Suzuki  1 , Masahiro Kobayashi  1 , Shunichirou Fujiyama  1 , Yusuke Kawamura  1 , Hitomi Sezaki  1 , Norio Akuta  1 , Yoshiyuki Suzuki  1 , Satoshi Saitoh  1 , Yasuji Arase  1 , Kenji Ikeda  1 , Mariko Kobayashi  2 , Hiromitsu Kumada  1
Affiliations
Affiliations

    1
    Department of Hepatology and.
    2
    Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan.

    PMID: 34687121 DOI: 10.1111/hepr.13726

Abstract

Background: Long-term use of nucleotide analogues such as adefovir (ADV) or tenofovir disoproxil fumarate (TDF) may cause renal impairment. Tenofovir alafenamide (TAF) has lesser systemic exposure than TDF. To examine longitudinal changes in renal function and biochemical parameters for two years after switching from long-term ADV and TDF to TAF and to explore factors associated with improved renal function after TAF in chronic hepatitis B (CHB) patients.

Methods: The prospective observational cohort study included 306 CHB patients who underwent switching from long-term TDF or ADV to TAF. The primary outcome was the changes in estimated glomerular filtration rate (eGFR) after TAF.

Results: Among 306 patients, 190 (65.3%) and 106 (34.7%) had chronic kidney disease (CKD) stages 1-2 and 3a-4 at baseline. In patients with CKD stage 3a-4, the mean eGFR significantly increased until week 12 and plateaued from week 12 to year 2 (Adjusted slope using linear mixed effect models: +9.01 ml/min/1.73 m2 /year until week 12; P < 0.001). In contrast, the mean eGFR plateaued from baseline to year 2 in the CKD stage 1-2 subgroup. Multivariate logistic regression showed that baseline CKD stage ≥ 3a, steeper decline in eGFR 1-year before TAF, and shorter duration of any nucleotide analogue use were significantly associated with ≥ 10% improvement in eGFR in year 1.

Conclusions: Switching from TDF or ADV to TAF resulted in favourable renal safety for 2 years. In CKD stage 3a-4 subgroup, eGFR after TAF was recovered in the first 12 weeks and subsequently stabilised. This article is protected by copyright. All rights reserved.

Keywords: ADV; ALT; BMI; CKD; ETV; HBV; HBeAg; HCC; LAM; OR; ROC; TAF; TDF; TRP; Tenofovir alafenamide; U-ACR; U-β2MG/Cr; adefovir dipivoxil; alanine aminotransferase; body mass index; chronic kidney disease; eGFR; entecavir; estimated glomerular filtration rate; hepatitis B e antigen; hepatitis B virus; hepatocellular carcinoma; lamivudine; odds ratio; receiver operating characteristic curve; sCr; serum creatinine; tenofovir alafenamide; tenofovir disoproxil fumarate; tubular reabsorption of phosphate; urine albumin creatinine ratio; urine β2-microglobulin creatinine ratio.

This article is protected by copyright. All rights reserved.

lancas

坦白讲，吃了TAF我的肾功能竟然比以前好了。。。。。至少可以说TAF的肾毒性不大。。。