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Chronic kidney disease progression in patients with chronic hepatitis B on tenofovir, entecavir, or no treatment
Author(s) -
Wong Grace LaiHung,
Chan Henry LikYuen,
Tse YeeKit,
Yip Terry CheukFung,
Lam Kelvin LongYan,
Lui Grace ChungYan,
Szeto CheukChun,
Wong Vincent WaiSun
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14945
Subject(s) - entecavir , medicine , tenofovir , chronic hepatitis , kidney disease , gastroenterology , hepatitis b , kidney , virology , lamivudine , virus , human immunodeficiency virus (hiv)
Summary 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 m 2 , 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.