Effect of tenofovir on renal function in patients with chronic hepatitis B - PubMed (original) (raw)

doi: 10.1097/MD.0000000000009756.

Jae Young Jang, Won Young Park, Soung Won Jeong, Hee Jeong Lee, Sang Joon Park, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim, Suyeon Park, Baigal Baymbajav

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Effect of tenofovir on renal function in patients with chronic hepatitis B

Woo Jin Jung et al. Medicine (Baltimore). 2018 Feb.

Abstract

Tenofovir disoproxil fumarate (TDF) is widely used to treat patients with hepatitis B virus (HBV) infection. We investigated the effect of TDF on renal insufficiency in patients with chronic hepatitis B (CHB).A consecutive cohort analysis was applied to CHB patients taking prescribed TDF from January 2012 to May 2016 at Soonchunhyang University Seoul Hospital. Alterations over time in corrected calcium, phosphate, creatinine, and estimated glomerular filtration rate (eGFR) were analyzed using the generalized estimating equation method. The percentage increase in creatinine from baseline to the maximum creatinine level (delta creatinine) was compared according to the underlying disease using the Mann-Whitney U test. Cox proportional hazard regression model was used to determine risk factors associated with renal insufficiency.The baseline creatinine, eGFR, corrected calcium, and phosphate levels were 0.72 ± 0.01 mg/dL (mean ± SD), 106.37 ± 1.06 mL/min/1.73 m, 8.82 ± 0.04 mg/dL, and 3.42 ± 0.05 mg/dL, respectively. The creatinine level had increased significantly at 12, 24, 48, 72, and 96 weeks, while the eGFR level had decreased significantly at these 5 time points. Multivariate analysis confirmed that age ≥60 years and the baseline bilirubin level were independently associated with the risk of renal insufficiency. Delta creatinine was significantly higher in patients with diabetes mellitus (DM) than in patients without DM.Renal function was decreased from baseline in CHB patients receiving TDF therapy, which indicates that the renal function of patients undergoing treatment with TDF should be monitored regularly. Old age, DM, and serum bilirubin were risk factors for the development of renal insufficiency in CHB patients receiving TDF therapy.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1

Figure 1

Flow chart of the study population. After excluding 205 of the 315 initially enrolled patients, the study population comprised 110 patients. CHB = chronic hepatitis B, eGFR = estimated glomerular filtration rate, TDF = tenofovir disoproxil fumarate.

Figure 2

Figure 2

Changes in creatinine, eGFR, corrected calcium, and phosphorus levels over time using the generalized estimating equation method. The cumulative mean changes in creatinine (A) and eGFR (B) were significantly related to the TDF exposure period. The mean corrected calcium (C) and phosphate (D) levels during therapy did not differ significantly from the baseline values. eGFR = estimated glomerular filtration rate, TDF = tenofovir disoproxil fumarate.

Figure 3

Figure 3

Differences in delta creatinine according to the underlying disease. Delta creatinine was significantly higher in patients with DM than in patients without DM (40.23 vs 27.86, P = .041), but it did not differ significantly between patients with or without HTN, age ≥60 or <60 years, and BMI ≥25 or <25 kg/m2. BMI = body mass index, DM = diabetes mellitus, HTN = hypertension.

Figure 4

Figure 4

Cumulative probability of renal insufficiency through TDF treatment. TDF = tenofovir disoproxil fumarate.

References

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