Abstract
Chronic hepatitis B virus (CHB) infection is one of the most common causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) worldwide. Many patients with CHB have variable degrees of functional renal impairment, and approximately 2 to 15% of patients on hemodialysis have CHB. Several therapeutic regimens have been developed in the past years, among which oral nucleoside and nucleotide analogues have been demonstrated to be efficient and well tolerated. However, they all are excreted in the urine and may thus require dosage adjustment in patients with decreased renal function. Furthermore, a number of them may in addition be toxic to the kidneys, especially in those patients presenting with renal insufficiency.
Highlights
Chronic hepatitis B virus (CHB) infection is one of the most common causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) worldwide [1, 2]
Nephrotoxicity manifesting as decrease in glomerular filtration rate (GFR) is more common in patients who are >50 years old, have baseline renal insufficiency, hypertension, and/or diabetes mellitus
Some individuals with hepatitis B virus (HBV) infection may be genetically predisposed to develop nephropathy [20] and a recent study suggested that HBV infection with elevated alanine aminotransferase (ALT), rather than HBV infection or elevated ALT alone, was significantly associated with reduced renal function, defined as an estimated glomerular filtration rate (GFR) lower than 60 mL/Min/1.73 m2 and/or albuminuria [21]
Summary
Chronic hepatitis B virus (CHB) infection is one of the most common causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) worldwide [1, 2]. NUC therapy had been shown to reverse fibrosis and cirrhosis and to reduce the risk of hepatic decompensation and hepatocellular carcinoma. NUCs are generally safe and well tolerated, but side effects have been reported including lactic acidosis, myopathy, nephrotoxicity, neuropathy, and decrease in bone mineral density. Nephrotoxicity with adefovir or tenofovir has been the most commonly reported side effect. Advances in Hepatology serum creatinine (estimated creatinine clearance) and serum phosphate levels during adefovir or tenofovir therapy in all CHB patients and with serum creatinine levels (estimated creatinine clearance) during nucleoside analogue therapy in CHB patients at high renal risk
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