Effect of telbivudine combined with adefovir on renal function in patients with chronic hepatitis B

Abstract

Objective To explore the effect of combination of telbivudine (LdT) and adefovir dipivoxil (ADV) on renal function in patients with chronic hepatitis B (CHB). Methods The CHB patients with renal injury due to lamivudine (LAM) resistance and combination with ADV, who visited in First Affiliated Hospital of Zhejiang Chinese Medical University were enrolled into this study. The randomized controlled trial was performed in this study. The patients were divided into two groups by table of random number: the LAM+ ADV group (original treatment was continued) and the LdT+ ADV group (LAM was replaced with LdT). The levels of HBV DNA, alanine aminotransferase (ALT), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), urinary beta 2-microspheres (Uβ2-MG), and serum creatine kinase (sCK) were compared between the 2 groups at baseline, 24 and 48 weeks of treatments. Results A total of 79 patients were enrolled into the study. There were 41 patients in the LAM+ ADV group and 38 in the LdT+ ADV group. The differences of sex distribution, age, body weight and the basal level between the 2 groups were not statistically significant (all P>0.05). There were no HBV DNA breakthrough in patients during 48 weeks of treatment in both groups. The differences of ALT levels at different time points in patients in the 2 groups were not statistically significant (all P>0.05). In the LAM+ ADV group, the Scr levels at 24 and 48 weeks of treatment were higher than those at baseline [(117±11), (122±12) μmol/L vs. (113±12) μmol/L]. The difference between the baseline and 48 weeks of treatment was statistically significant (P 0.05). The sCK levels in the LdT+ ADV group at 24 and 48 weeks of treatments were higher than those at baseline[(107±38), (130±56) U/L vs. (97±31) U/L]. The difference between the baseline and 48 weeks of treatment was statistically significant (P<0.05). The differences of Scr, eGFR, Uβ2-MG, and sCK levels at baseline and 48 weeks of treatment in the 2 groups were statistically significant (all P<0.05). Conclusions The therapeutic regimen of telbivudine combination with adefovir dipivoxil can improve the renal function in patients with CHB. The change of sCK level should be monitor closely during the treatment. Key words: Telbivudine; Adefovir dipivoxil; Renal insufficiency; Hepatitis B, chronic