Analysis Of Renal Function Chages In Patients With Chronic Hepatitis B Treated With Nucleos(t)ide Analogs

BackgroundChronic hepatitis B(CHB),one of a major infectious diseases in China,is a serious global public health problem and the treatment of CHB requires a long-term process.The currently recommended first-line oral antiviral drugs.Nucleos(t)ide analogs(NAs)have been used in the treatment of patients with CHB for more than 20 years.With the renewal of medical technology and antiviral drugs,we require NAs to inhibit the replication of hepatitis B virus(HBV)effectively for a long time to reduces the occurrence of cirrhosis and hepatocellular carcinoma(HCC),but we also need good drug safety to improve the quality of life and to prolong the survival of patients.Tenofovir dipyridamole fumarate(TDF)is a first-line oral antiviral drug for CHB,but it is controversial because of its kidney safety and strong preventive effect on hepatocellular carcinoma.At present,most CHB patients in China are infected before hepatitis B vaccination.The age of these patients is about 30～50 years old.As the age of the patients increases,the risk of hypertension,diabetes and other diseases also increases.Aging can lead to the decline of renal function.Hypertension,diabetes and other diseases can cause damage to the kidney.Kidney is an important excretory organ of the body,whose safety is an important consideration for the choice of oral antiviral drugs.For patients with moderate to severe renal impairment(eGFR<60 ml/min/1.73m2),EASL guidelines recommend that tenofovir alafenamide(TAF)or entecavir(ETV)be used first.But for patients without significant kidney damage,non-elderly age,and no risk of related diseases,whether TDF increases the risk of renal damage in CHB patients compared with ETV remains unclear.The effects of ETV and TDF on the renal function of CHB patients remain to be further studied.ObjectiveThis study aims to compare the renal function of ETV and TDF and explore the renal function of medication time during treatment,analyze the predictive factors of moderate to severe renal damage in patients with CHB,so as to provide the basis for the selection of NAs.MethodsA total of 930 newly treated CHB patients in Nanfang Hospital of Southern Medical University from January 2017 to June 2018 are included and divide into two groups according to the initial treatment plan.The SPSS software version 22.0 is used to compare the clinical data between ETV group and TDF group.A total of 440 matched patients with the same baseline characteristics in the two treatment groups are screened by the application of propensity score matching(PSM).Cox regression analysis are used to analyze the eGFR of matched patients during antiviral therapy,and to analyze the predictive factors of moderate to severe renal damage in patients with CHB during antiviral therapy.Results1.A total of 930 CHB patients are enrolled in the study,including 725(77.9%)males,205(22.1%)females,696(74.8%)in the ETV treatment group,and 234(25.2%)in the TDF treatment group.A total of 440 matched patients are selected,including 220 patients treated with ETV and 220 patients treated with TDF.2.The analysis results of eighteen months of ETV and TDF showed that in CHB patients with normal(eGFR≥90 ml/min/1.73m2)or slightly impaired renal function(90>eGFR≥ 60 ml/min/1.73 m2),the adjusted mean eGFR is similar between patients received ETV treatment and TDF treatment.3.Cox regression analysis shows that in CHB patients,baseline eGFR is an independent predictor of moderate to severe renal impairment during antiviral therapyConclusionsThe cohort of CHB patients is predominantly male,and most patients treated with ETV.We applied a propensity score matching method to screen out cohorts with similar baseline characteristics for further study and it showed that CHB patients with normal or slightly impaired renal function(eGFR≥ 60 ml/min/1.73m2)have no significant difference in the effects of ETV or TDF on their renal function within 18 months.Cox regression model analysis showed that baseline eGFR was an independent predictor of moderate to severe renal impairment during antiviral therapy in CHB patients.