An observational study on long-term renal outcome in patients with chronic hepatitis B treated with tenofovir disoproxil fumarate.

Abstract

In patients with chronic hepatitis B (CHB), long-term effects of tenofovir disoproxil fumarate (TDF) on renal function have been controversial. This study aimed to analyse the real-world long-term effects of TDF on renal function in Korean patients with CHB. We analysed a cohort of 640 treatment-naïve patients with CHB who were treated with TDF between May 2012 and December 2015 at Severance Hospital, Seoul, Republic of Korea. The mean age was 48.3years old, and 59.5% were male. The proportions of hypertension and diabetes mellitus (DM) were 11.6% and 14.2%, respectively, and that of liver cirrhosis was 20.8%. During the 5-year follow-up, using a linear mixed model, serum creatinine increased from 0.77±0.01mg/dL to 0.85±0.02mg/dL (P<.001), and eGFR decreased from 102.6±0.6mL/min/1.73m2 to 93.4±1.4mL/min/1.73m2 (P<.001). In subgroup analysis, eGFR was statistically more decreased in patients with age>60 than ≦60years old (P=.027), and in patients with diuretic use than without diuretic use (P=.008). In multivariate analysis, the independent risk factors for eGFR decrease>20% were baseline eGFR<60mL/min/1.73m2 (P=.034) and the use of diuretics (P<.001). CHB patients on TDF experienced greater reduction in renal function with age>60 and with diuretic use compared to those without these characteristics. Baseline eGFR<60mL/min/1.73m2 and use of diuretics were independent risk factors of eGFR decline of more than 20% on TDF therapy.