The impact of antiviral treatment with tenofovir on the renal function of patients with chronic hepatitis B

Abstract

Abstract: Objective To evaluate the renal safety of tenofovir disoproxil (TDF) in the treatment of chronic hepatitis B (CHB) patients and the risk factors for renal function damage. Methods A total of 113 CHB patients received TDF treatment were collected as TDF treatment group. 65 patients received entecavir (ETV) were collected as ETV treated control group. The patient's clinical data and renal function test were collected at baseline, and 12 and 24 months after treatment. Results After 24 months of treatment, there was no significant difference in the conversion rate of HBV DNA (92.9% in TDF group vs 90.8% in ETV group), the recovery rate of ALT (85.0% in TDF group vs 83.1% in ETV group) and the conversion rate of HBeAg (55.5% in TDF group vs 47.2% in ETV group) between the TDF treatment group and the ETV treatment group(χ²=0.263,P=0.608;χ²=0.110, P=0.740;χ²=0.601,P=0.438). At 24 months of treatment, the blood creatinine level in TDF treatment group was significantly increased, with an average increase of 10.8±4.7 μmol/L (t=2.83,P=0.041),whereas the eGFR level was significantly decreased from baseline, with an average decrease of 11.8±1.5 ml/min/1.732 (t=3.728, P=0.034). A total of 14 patients (12.4%) had renal function impairment (eGFR levels were≥25% lower than baseline), but no patients had chronic kidney disease (CKD). Seven patients developed proximal tubular renal dysfunction. Multivariate logistic regression analysis showed that those patients older than 50 years old (OR: 2.821, 95% CI: 1.084-7.342, P=0.034), with diabetes (OR: 2.072, 95% CI: 1.035-4.150, P=0.040) and with past experience of adefovir dipivoxil (ADV) treatment (OR: 3.162, 95% CI: 1.182-7.737, P=0.024) were independent risk factors associated with renal impairment. Conclusion In CHB patients treated with TDF, eGFR tends to decline and renal impairment may develop with the prolongation of treatment time. Oder age, diabetes, and previous ADV use are risk factors associated with renal impairment. Therefore, the renal function of patients receiving long-term TDF treatment should be carefully evaluated and monitored to prevent the occurrence of adverse reaction.

Key words: Chronic hepatitis B, Tenofovir, Renal function, Glomerular filtration rate

HAN Zong-ru, MIN Xiao-chun, SHEN Qi-gang, YIN You-kuan, WANG Sen. The impact of antiviral treatment with tenofovir on the renal function of patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2021, 26(11): 1216-1220.

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