Abstract
BackgroundIn China, more than 20 million patients with chronic hepatitis B need antiviral treatment. Side effects of antiviral treatment such as renal complications can be problematic, particularly in an aging population.MethodsThe data were retrospectively extracted from the hospital medical charts of five centers in eastern China from January 1 to December 31, 2018.ResultsA total of 8309 patients with CHB was enrolled in this study. The median age of the patients was 46 years. The prevalence of diabetes mellitus, hypertension, and hepatic cirrhosis was respectively 3.49%, 4.42%, and 23.72%. The prevalence of these comorbidities increased with age (P < 0.001). Of the patients with CHB, 5332 had complete renal function results. Among them, patients with an estimated glomerular filtration rate of < 60 mL/min/1.73m2 accounted for 4.14%, and those with proteinuria for 8.33%. According to the definition of chronic kidney disease, the proportion of patients with chronic kidney disease was 11.37%. The prevalence of chronic kidney disease increased with age (P < 0.001). In a multivariate analysis, age group [odds ratio (OR) = 2.387], diabetes mellitus (OR = 1.486), hypertension (OR = 2.557), hepatic cirrhosis (OR = 1.295), and a history of exposure to adefovir dipivoxil (OR = 1.644) were significantly associated with CKD (P < 0.05). Among patients with CKD, 17.66% (107/606) had a history of lamivudine exposure, and 34.65% (210/606) had a history of nucleotide analogue exposureConclusionThe management of Chinese patients with CHB should take into consideration age, previous medication history, and renal impairment.
Highlights
Hepatitis B virus (HBV) infection is a major public-health challenge worldwide
After reviewing patient medical charts, patients with chronic hepatitis B (CHB) who met the following criteria were enrolled in the study: age ≥ 18 years; HBV surface antigen (HBsAg) positive for > 6 months; eligible for antiviral treatment according to the 2015 China HBV Guidelines; visited one of study hospitals from January 1 to December 30, 2018 and on nucleotide/nucleoside antivirals; no co-infection with hepatitis A virus, hepatitis C virus, hepatitis D virus, hepatitis E virus, or human immunodeficiency virus; no liver dysfunction of other causes; no concomitant liver or non-liver malignancy; and no pregnancy or lactation
Data collection and definitions The following data were extracted from electronic medical charts: demographics; medical history [diabetes mellitus (DM) and hypertension identified by International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code]; antiviral treatment; liver-related complications; and liver cirrhosis
Summary
Hepatitis B virus (HBV) infection is a major public-health challenge worldwide. In particular, China has a high rate of morbidity due to HBV infection. Due to hepatitis B vaccination, the incidence of HBV infection in children and young people has declined significantly [2, 5]. In an observational study of HBV infection in China from 2004 to 2014, the rate of infection was significantly lower in people less than 24 years of age but significantly higher in those more than 55 years of age [6]. Carriers of hepatitis B virus are aging, those infected before the introduction of hepatitis B vaccination. In China, more than 20 million patients with chronic hepatitis B need antiviral treatment. Side effects of antiviral treatment such as renal complications can be problematic, in an aging population
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