Impact Of Nucleos(t)ide Analogues On The Estimated Glomerular Filtration Rate In Patients With Chronic Hepatitis B

Objective :To studies Impact of nucleos(t)ide analogues on the estimated glomerular filtration rate in patients with chronic hepatitis B(CHB).Methods :184 patients with chronic hepatitis B admitted to Department of Infectious diseases, the Second Affiliated Hospital of Dalian Medical University in September of2010 ~ 2014 were retrospectively studied. All patients were randomly divided into the adefovir group(group ADV, 58 cases), the telbivudine group(group LDT, 62 cases)and the entecavir group(group ETV, 64 cases). And patients in every group received oral antiviral treatment for 104 weeks. It was compared that glomerular filtration rate(e GFR), creatinine(Scr) changes and biochemical response, virological, serological conversion of HBe Ag of pre and post treatment in every group.Results :1.There was no significant difference of the changes of Scr, e GFR at 52 and104 weeks between the group ETV and the baseline(P >0.05);compared with the baseline, the value of Scr in group ADV at 52 and 104 weeks represented an increase of 4 μmol/L(74 vs. 70 umol/L, P =0.018), 9 μmol/L(79 vs. 70 umol/L, P =0.008)respectively,there had statistically significant difference.while the value of e GFR was gradually decreasing, the value in group ADV at 52 weeks and 104 weeks less than the baseline, with a decrease of 6.9 m L/min/1.73 m2(102.7 vs. 109.6 m L/min/1.73 m2 P =0.004), 16.9 m L/min/1.73 m2(92.7 vs. 109.6 m L/min/1.73 m2 P <0.001), the difference had statistical significance. and the value of Scr in group LDT has steadily decreased after the treatment of LDT, and reduced 6 μmol/L(67 vs 73 umol/L P=0.007), 14 μmol/L(59 vs 73 umol/L P =0.003) over the baseline at 52 and 104weeks, respectively. while the values of e GFR had been steadily rising, with an increase of 10.3 m L/min/1.73 m2(110.1 vs 99.8 m L/min/1.73 m2 P =0.002), 23.4m L/min/1.73 m2(123.2 vs 99.8 m L/min/1.73 m2 P <0.001) at 52, 104 weeks over the baseline, the difference had statistical significance.2.There was no statistically significant difference of e GFR constituent ratios between group ADV and LDT(P =0.078), and there had significant differences of e GFR constitutes between the group after the treatment of 104 weeks(P <0.001). The values of e GFR of 9 cases in group LDT were lower than 90 m L/min/1.73 m2, the levels of e GFR of 77.78%(7/9) patients were more than 90 m L/min/1.73 m2, and the total number of patients with e GFR>90 ml/(min.1.73 m2) had risen from 53 cases(85.48%)to 59 cases(95.16%). There were 42 cases of patients with e GFR≥90 m L/min/1.73 m2(72.41%) in group ADV. After the treatment of 104 weeks, there were 23.81% of patients(10/42) with e GFR levels to < 90 m L/min/1.73 m2; and there were 16(27.59%) patients with e GFR<90 m L/min/1.73 m2, rising to 21 cases(36.21%) after the treatment of 104 weeks in baseline.3.There was no significant difference of normalization rates of ALT(P =0.647),negative conversion rates of HBV-DNA(P =0.589), seroconversion rate of HBe Ag(P=0.256) after the treatment of 104 weeks between the group ETV and the group LDT;there was a significant difference of normalization rates of ALT(P =0.038), negative conversion rates of HBV-DNA(P =0.005), seroconversion rate of HBe Ag(P =0.012)between the group ADV and the group LDT; and there had statistically significant difference of normalization rates of ALT(P =0.005), negative conversion rates of HBV DNA(P <0.001) between the group, while there was no significant difference of seroconversion rate of of HBe Ag(P =0.146),Conclusion:The treatment of LDT may increase the e GFR, and significantly improved renal function; however the therapy of ADV may lower the e GFR, with potential risk of kidney damage; the value of e GFR may reflect the renal injury much earlier than Scr during the treatment of NAs in patients with CHB. The renal function-protecting mechanisms of LDT should be further studied.