Entecavir and tenofovir on renal function in patients with hepatitis B virus-related hepatocellular carcinoma.

Abstract

The use of tenofovir disoproxil fumarate (TDF) is associated with a risk of renal dysfunction. We investigated whether TDF is associated with the deterioration of renal function in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) requiring frequent computed tomography (CT) evaluations and transarterial chemoembolization (TACE) sessions, when compared to entecavir (ETV). Between 2007 and 2017, 493 patients with HBV-related HCC were enrolled. The number of CT evaluations and TACE sessions were collected through 3years of follow-up. The median age of the study population (373 men and 120 women; 325 with ETV and 168 with TDF) was 56.5years. TDF was significantly associated with a serum creatinine increase (≥25% from the baseline; unadjusted hazard ratio [uHR]=1.620) and an estimated glomerular filtration rate (eGFR) reduction (<20% from the baseline) (uHR=1.950) (all P<.05), when compared to ETV. In addition, CT evaluations≥4 times/year were significantly associated with a serum creatinine increase (uHR=2.709), eGFR reduction (uHR=3.274) and chronic kidney disease (CKD) progression (≥1 CKD stage from the baseline) (uHR=1.980) (all P<.05). In contrast, TACE was not associated with all renal dysfunction parameters (all P>.05). After adjustment, TDF use was independently associated with the increased risk of eGFR reduction (adjusted HR [aHR]=1.945; P=.023), whereas CT evaluation ≥4 times/year was independently associated with the increased risk of serum creatinine increase (aHR=2.898), eGFR reduction (aHR=3.484) and CKD progression (aHR=1.984) (all P<.01). In conclusion, patients with HBV-related HCC treated with TDF and frequent CT evaluations should be closely monitored for the detection of associated renal dysfunction.