Clinical Efficacy Of Entecavir Switch In Chronic Hepatitis B Patients With Kidney Injury Associated With Adefovir Dipivoxil

Objective:Adefovir dipivoxil treatment of chronic hepatitis B may develop early and advanced kidney injury,this article aimed to observe the changes of renal function after switching from adefovir dipivoxil to entecavir.Methods:A retrospective study was performed to analyze a series of parameters of 20 chronic hepatitis B patients with adefovir dipivoxil associated kidney injury after switching to entecavir at baseline,4 weeks,12 weeks and 24 weeks,including glomerular filtration rate(GFR),endogenous creatinine clearance rate(Ccr),cystatin C,blood ?2-microglobulinbeta(?2-MG),blood retinol binding protein(RBP),urine N acetyl glucosidase(NAG),urine ?1-microglobulin(?1-MG),hepatitis B virus(HBV-DNA),alanine aminotransferase(ALT),alphafetoprotein(AFP)and blood phosphorus.Results:Before the switch of drug,the markers of early kidney injury including blood Cys C and ?2-MG were(1.23 + 0.26)mg/L and(3.40 + 0.69)mg/L,respectively.While GFR and Ccr as indicators of advanced stage kidney injury were(61.93 + 16.23)m L/min and(61.30 + 15.67)m L/min,respectively.However,after ETV switch for 24 weeks,the markers of early kidney injury blood Cys C,blood ?2-MG and of advanced stage kidney injury GFR and Ccr were improved,with(1.13 + 0.22)mg/L?(2.77 + 0.69)mg/L and(77.12 + 18.66)m L/min?(76.01 + 18.27)m L/min,respectively,(all P < 0.05),respectively.Additionally,blood Cys C and ?2-MG started to be improved at 4 weeks and 12 weeks,respectively,both of which continued to be improved at 24 weeks.However,blood RBP,urine NAG and ?1-MG had no significant improvement.Compared to the baseline,GFR was increased by 24.53% in 18 patients switching to entecavir,and decreased by 1% and 10.46% in 2 patients respectively.Ccr was improved by 24%,that of 8 patients went back to normal,of 10 patients got improved than before and of 2 patients decreased by 2.13% and 10.02%,respectively.There was no significant change of blood phosphorus after 24 weeks.Virological and biochemical responses were maintained for 24 weeks in 20 patients who continued antiviral therapy with entecavir.Conclusion:The markers of early and advanced kidney injury can be improved obviously when switching to entecavir in patients with chronic hepatitis B who suffered from renal dysfunction associated with adefovir dipivoxil.