Renal Impairment During Long-term Adefovir Dipivoxil Treatment In Chronic Hepatitis B Patients

Objective:To evaluate the renal function of patients with chronic hepatitis B during long-term adefovir dipivoxil or entecavir therapy, and the risk factors of adefovir associated renal impairment.Method:This retrospective analysis involved90patients receiving antiviral therapy more than2years,45patients receiving adefovir dipivoxil(7patients adefovir monotherapy, and another37patiens combination therapy with lamivudine) and45patients receiving entecavir therapy. HBV DNA negative rate, ALT level normalized rate. HBeAg negative rate, Serum creatinine, estimates of glomerular filtration rate was observed on12weeks,24weeks,48weeks,72weeks,96weeks, compared with baseline. In adefovir dipivoxil group, the percentage of patiens with urine IgG, urine microalbuminuria, urine β2microglobulin, RBP is record down.Results:After the96-week treatment, the HBV DNA negative rate is82.8%and3.3%in adefovir and entecavir therapy group(p<0.05), and the ALT level normalized rate is44%and47.8%(p>0.05), p>0.05),with statistical difference. Compared with the baseline, the serum creatinine is+18.2umol/L and+2.5umol/L (p<0.05) in adefovir and entecavir therapy group on96weeks, the estimates of glomerular filtration rate is -14.6ml/min/1.73m2and-1.6ml/min/1.73m2(p<0.05) in adefovir and entecavir therapy group on96weeks; In the adefovir therapy group,13patients was observed with urine micro-protein abnormal, urine β2microglobulin abonormal was observed in8patents, and RBP was observed in9patients. The average treatment duration of the patients and the age of the patients is a risk factor of the renal impairment. The entecavir therapy group has only7patients have finished the urine microalbuminuria examination.Conclusion:The HBV DNA negative rate is higher in entecavir therapy group compared with adefovir therapy group, there are no Statistical difference in the ALT level normalized rate and HBeAg negative rate between the two groups. Long-term adefovir therapy may results in renal impairment, with clinical features:decrease in the estimates of glomerular filtration rate, Increased serum creatinine, increased urine microprotein; there is no significant adverse effect of entecavir therapy on renal function. Age and the duration of adefovir therapy may the risk factors in adefovir-associated renal impairment...