Influence Of Adefovir Dipivoxil, Tebivudine, Entecavir Therapy On Renal Function In Patients With Chronic Hepatitis B

Objective To evaluate the changes in the renal function of patients with chronic hepatitis B(CHB) receiving adefovir dipivoxil(ADV) or telbivudine(L-DT) or entecavir monotherapy.Methods This retrospective analysis involved 206 patients with CHB who were treated with ADV or Ld T or ETV monotherapy for 6months,12 months and 24 months.The relations among the three Nucleotide drugs,Serum creatinine, estimates of glomerular filtration rate(e GFR) were compared.Results 1.The mean changes of SCr at 6months from baseline were-3.58(81.20 vs 77.62mg/dl,p=0.078) in Ld T group, +4.27(80.69 vs 84.96mg/dl,p=0.057)in ADV group,-1.57mg/dl(83.82 vs 82.25mg/dl,p=0.084)in ETV group.The median changes of e GFR at 6months from baseline in three groups were 12.92%(89.78 vs 101.38, p=0.087) in Ld T group,-1.53%(94.11 vs 95.53,p=0.103)in ADV group, 5.39%(91.96 vs 96.92,p=0.091)in ETV group. The mean changes of SCr at 12 months from baseline were-5.76(81.20 vs 75.44mg/dl,p=0.046) in Ld T group, +6.24(80.69 vs 86.93mg/dl,p=0.039)in ADV group,-2.83mg/dl(83.82 vs 80.99mg/dl,p=0.057)in ETV group.The median changes of e GFR at 12 months from baseline in three groups were 13.66%(89.78 vs 102.04, p=0.069)in Ld T group,-2.89%(94.11 vs 91.47,p=0.043)in ADV group, 8.41%(91.96 vs 99.69,p=0.049)in ETV group. The mean changes of SCr at 24 months from baseline were-8.62(81.20 vs 72.58mg/dl,p=0.000)、+9.01(80.69 vs 89.70mg/dl,p=0.000)、-4.38(83.82 vs 79.43mg/dl,p=0.032)in the groups, respectively.The median changes of e GFR at 24 months from baseline in three groups were+17.9%(89.78 vs 107.68, p=0.000)、-5.65%(94.11 vs 89.07,p=0.003)、+11.62%(91.96 vs 102.65,p=0.001), respectively. 2.In patients with a baseline e GFR<90 ml·min-1·1.73 m-2, 92.11(35/38)of Ld T group,25.00(5/20)of ADV group and 68.97(20/29)of ETVgroup shifted to e GFR ≥90 ml·min-1·1.73 m-2 after 24 months(Ld T vs ADV, p=0.000; Ld T vs ETV, p=0.215; ADV vs ETV,p=0.01).In patients with a baseline e GFR≥90 ml·min-1·1.73 m-2, 21.21%(7/33)of Ld T group,44.00%(22/50)of ADV group and 19.44%(7/36)of ETVgroup shifted to e GFR<90 ml·min-1·1.73 m-2 after 24 months. The proportion of patients with e GFR≥90ml·min-1·1.73 m-2 in Ld T group increased from 46.48% at baseline to 85.92% at 24 months and this similar raising was also found in ETV group(55.38% to 75.38%) while that in ADV group decreased from71.43% at baseline to 47.14%.The constituent ratios of e GFR at different levels were similar at baseline but significantly different at 24 months between the three groups(Ld T vs ADV, p=0.001,Ld T vs ETV, p=0.181,ADV vs ETV, p=0.035).Conclusion(1)、Telbivudine treatment was associated with improvement of renal function in patients with CHB。(2)、Entecavir treatment was possibly associated with improvement of renal function in patients with CHB。(3)、ADV treatment may be associated with a risk of nephrotoxicity in patients with CHB, which increased gradually with long term use of ADV。...