Abstract
BackgroundThe change of estimated glomerular filtration rate (eGFR) with off-treatment nucleos(t)ide analogues (NA) in chronic hepatitis B patients (CHB) is unclear. This study is aimed to evaluate the off-treatment eGFR after 3 years of therapy with telbivudine (LdT) or entecavir (ETV) and to assess predictive factors for eGFR improvement.MethodsFrom January 2009 to December 2011, we identified NA-naïve patients who were at least 20 years of age diagnosed with compensated CHB. All patients received a 3-year NA treatment and 1 year off-treatment follow-up; the initial selection of patients for LdT or ETV treatment was at the physicians’ discretion. An increase of more than 10% in eGFR from the baseline was identified as an improvement. The change of chronic kidney disease stages were recorded and compared with baseline at year 3 and year 4, respectively.ResultsThis study included two groups consisting of 46 patients each (each with3 years of treatment with LdT or ETV). In LdT-treated patients, the mean eGFR increased from 94.3 ± 28.3 to 104.0 ± 31.2 mL/min/1.73 m2 in year 3 (p = 0.01) and from 104.0 ± 31.2 to 104.0 ± 28.8 mL/min/1.73 m2 in year 4 (p = 0.99). However, in ETV-treated patients, the mean eGFR decreased from 93.1 ± 26.1 to 85.5 ± 25.1 mL/min/1.73 m2 in year 3 (p = 0.0009) and from 85.5 ± 25.1 to 87.7 ± 24.8 mL/min/1.73 m2 in year 4 (p = 0.2). After a multivariate analysis, the predictors for the off-treatment eGFR improvement were the LdT treatment (odds ratio [OR], 3.97 (1.37–11.5), p = 0.01) and pre-treated eGFR (OR, 0.98 (0.95–1.00), p = 0.04).ConclusionsAt year 4, 48.8 and 21.3% patients had an improved eGFR from baseline in LdT and ETV patients, respectively. Telbivudine may have a protective renal effect that can last for one year after treatment in non-cirrhotic CHB patients without a virological breakthrough.
Highlights
The change of estimated glomerular filtration rate with off-treatment nucleos(t)ide analogues (NA) in chronic hepatitis B patients (CHB) is unclear
NAs are effective in suppressing hepatitis B virus (HBV) replication, most patients require long-term treatment
The demographics and characteristics of 92 HBV patients assigned to treat with LdT or ETV A total of 180 CHB patients were enrolled in this retrospective study, of which 89 patients were treated with LdT and 91 patients were treated with ETV according to the Taiwanese Health Insurance Guidelines
Summary
The change of estimated glomerular filtration rate (eGFR) with off-treatment nucleos(t)ide analogues (NA) in chronic hepatitis B patients (CHB) is unclear. NAs are effective in suppressing hepatitis B virus (HBV) replication, most patients require long-term treatment. The effects of HBV infection or treatment agents on the renal dysfunction in CHB patients require further studies. There are currently 5 oral antiviral agents for CHB: 2 nucleotides (adefovir and tenofovir) and 3 nucleosides (lamivudine, entecavir (ETV), and telbivudine (LdT)). All of these oral antiviral agents are primarily eliminated unchanged through the renal route, can have an effect on the mitochondrial or proximal tubular microstructures. In a large cohort of patients with CHB receiving LdT, the estimated GFR (eGFR) [using MDRD formula] increased by 14.9 mL/min or by 16.6% from baseline to year 4 [5]
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