Alternative Study Of The Effects Of Tebivudine And Entecavir On Adefovir Dipivoxil Indduces Renal Impairment Patients With Chronic Hepatitis B

Objective To evaluate the influence on renal function in patients with chronic hepatitis B (CHB) recieving adefovir dipivoxil (ADV) induced renal damage after changing to telbivudine (LdT) or entecavir(ETV).Methods This retrospective analysis involved 478 patients with CHB who were treated with ADV or LdT or ETV monotherapy or ADV treatment of inducing renal damage after changing in LdT(ADV to LdT is group 1) or ETV(ADV to LdT is group2) for 144weeks. Serum creatinine, estimates of glomerular filtration rate (eGFR), and the percentage of patients with eGFR≥90 ml-min-1·1.73 m-2 at 144 weeks were compared with the baseline data between the five groups.Results The mean changes of SCr at 144 weeks from baseline were+0.084 mg/dl in ADV group,-0.099 mg/dl in LdT group,+0.013 mg/dl in ETV group (0.887 vs 0.900mg/dL, p=0.33),-0.306 mg/dl in group1,-0.118 in group2 (ADV group vs LdT group,p=0.00;LdT group vs groupl,p=0.00; ADV group vs group1, ADV group vs group2,p=0.00, LdT group vs group2,p=0.00,group1 vs group2,p=0.00,ADV group vs LdT group vs ETV group vs group1 vs group2,p=0.00).The median changes of eGFR at 144weeks from baseline in three groups were -7.479,+5.733,-0.030 (98.441 vs 99.537ml·min1·1.73m-2,p=0.08),+18.848,+1.435mL.min-1.1.73m-2,showing a significant difference between the five groups or five groups of two(p=0.00). In patients with a baseline eGFR< 90 ml·min-1·1.73 m-2,80%,0,0 of LdT group,group1,group2 shifted to eGFR≥90 ml·min-1·1.73 m-2 after 144 weeks were 78.57%(11/14),30.3%(10/33),16.67%(6/36) respectively, In patients with a baseline eGFR≥90 ml·min-1·1.73 m-2,70.61%,79.17% of ADV group and ETV group shifted to 55.51%,74.71% after 144 weeks.The constituent ratios of eGFR at different levels were similar(ADV vs LdT vs ETV vs group1 vs group2,p=0.29) at baseline but significantly different at 144 weeks between the five groups(p<0.05).Conclusion 1.Telbivudine treatment was associated with improvement of renal function in patients with CHB,especilly with a baseline eGFR<90 ml·min-1·1.73 m-2;2.Entecavir treatment was not associated with improvement of renal function in patients with CHB;3.ADV treatment associated with a risk of nephrotoxicity in patients with CHB-renal function damage caused by ADV was changed to LdT has significantly improved than changed to ETV.