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Aliment Pharmacol Ther. 2018 Nov;48(9):984-992. doi: 10.1111/apt.14945. Epub 2018 Aug 20.

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

1
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
2
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
3
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
4
Carol and Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.

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.

PMID:
30125952
DOI:
10.1111/apt.14945

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