Entecavir and tenofovir on renal function in patients with hepatitis B virus-related hepatocellular carcinoma

J Viral Hepat. 2020 Sep;27(9):932-940. doi: 10.1111/jvh.13313. Epub 2020 May 28.

Abstract

The use of tenofovir disoproxil fumarate (TDF) is associated with a risk of renal dysfunction. We investigated whether TDF is associated with the deterioration of renal function in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) requiring frequent computed tomography (CT) evaluations and transarterial chemoembolization (TACE) sessions, when compared to entecavir (ETV). Between 2007 and 2017, 493 patients with HBV-related HCC were enrolled. The number of CT evaluations and TACE sessions were collected through 3 years of follow-up. The median age of the study population (373 men and 120 women; 325 with ETV and 168 with TDF) was 56.5 years. TDF was significantly associated with a serum creatinine increase (≥25% from the baseline; unadjusted hazard ratio [uHR] = 1.620) and an estimated glomerular filtration rate (eGFR) reduction (<20% from the baseline) (uHR = 1.950) (all P < .05), when compared to ETV. In addition, CT evaluations ≥4 times/year were significantly associated with a serum creatinine increase (uHR = 2.709), eGFR reduction (uHR = 3.274) and chronic kidney disease (CKD) progression (≥1 CKD stage from the baseline) (uHR = 1.980) (all P < .05). In contrast, TACE was not associated with all renal dysfunction parameters (all P > .05). After adjustment, TDF use was independently associated with the increased risk of eGFR reduction (adjusted HR [aHR] = 1.945; P = .023), whereas CT evaluation ≥4 times/year was independently associated with the increased risk of serum creatinine increase (aHR = 2.898), eGFR reduction (aHR = 3.484) and CKD progression (aHR = 1.984) (all P < .01). In conclusion, patients with HBV-related HCC treated with TDF and frequent CT evaluations should be closely monitored for the detection of associated renal dysfunction.

Keywords: computed tomography; entecavir; renal insufficiency; tenofovir.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents* / therapeutic use
  • Carcinoma, Hepatocellular* / drug therapy
  • Carcinoma, Hepatocellular* / virology
  • Chemoembolization, Therapeutic
  • Creatinine / blood
  • Female
  • Glomerular Filtration Rate
  • Guanine / analogs & derivatives*
  • Guanine / therapeutic use
  • Hepatitis B virus
  • Hepatitis B, Chronic* / drug therapy
  • Humans
  • Kidney / drug effects*
  • Kidney Function Tests
  • Liver Neoplasms* / drug therapy
  • Liver Neoplasms* / virology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tenofovir* / therapeutic use
  • Treatment Outcome

Substances

  • Antiviral Agents
  • entecavir
  • Guanine
  • Tenofovir
  • Creatinine