Abstract
Nucles(t)ide analogs (NAs) are effective for chronic hepatitis B (CHB). NAs suppress hepatic decompensation and hepatocarcinogenesis, leading to a dramatic improvement of the natural course of patients with CHB. However, renal dysfunction is becoming an important issue for the management of CHB. Renal dysfunction develops in patients with the long-term treatment of NAs including adefovir dipivoxil and tenofovir disoproxil fumarate. Recently, several studies have reported that the newly approved tenofovir alafenamide (TAF) has a safe profile for the kidney due to greater plasma stability. In this mini-review, we discuss the effectiveness of switching to TAF for NAs-related renal tubular dysfunction in patients with CHB.
Highlights
Tubular dysfunction and patients with no renal tubular dysfunction. In this mini-review, we focused on nucleos(t)ide analogs (NAs)-related renal tubular dysfunction, which is. In this mini-review, we focused on NAs-related renal tubular dysfunction, which is becoming an important issue in the era of long-term NA treatment for chronic hepatitis B (CHB)
We reviewed becoming an important issue in the era of long-term NA treatment for CHB
We reviewed previous studies and proposed that switching to tenofovir alafenamide (TAF) is an important therapeutic strategy previous studies and proposed that switching to TAF is an important therapeutic strategy for CHB patients with NAs-related renal tubular dysfunction, in particular, in patients for CHB patients with NAs-related renal tubular dysfunction, in particular, in patients ≥61
Summary
Long-term ETV treatment has been reported to inhibit hepatocarcinogenesis compared to patients with non-treated CHB with a hazard ratio of 0.37 [7]. Renal tubular dysfunction has been known to develop in CHB patients, treated with NAs, including ADV and TDF [9]. Renal tubular dysfunction is becoming an important issue for the management of CHB patients treated with ADV/TDF. More than 150 cases of hypophosphatemia osteomalacia or Fanconi syndrome have been reported with long-term HBV treatment by ADV [22,23]. Age ≥ 40 years, decreased eGFR at the start of ADV treatment, hypertension, diabetes, cirrhosis, East Asian ethnicity, low body mass index, treatment with ADV for more than 24 months, residence in rural areas, and prior use of nephrotoxic drugs as risk factors for ADV-induced Fanconi syndrome in CHB patients [22–24]. TDF has a risk for Fanconi syndrome in patients with HBV [25], the risk factor remains unclear
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