Effects Of Long-term Oral Administration Of Nucleoside(Acid) Class Antiviral Drugs On Renal Function And Bone Mineral Density In Patients With Chronic Hepatitis B

Objective to study the effect of long-term administration of nucleoside(acid)antiviral drugs on renal function and bone density in patients with chronic hepatitis B.Methods data of patients with chronic hepatitis B treated with oral nucleoside(acid)antivirals for 4 years or more from January 2017 to February 2018 were collected.They were divided into adefovir dipivoxil group,adefovir dipivoxil combined with lamivudine group,entecavir group and lamivudine group.All patients were divided into the group with high risk factors of renal injury and the group without high risk factors of renal injury.The modification of the renal disease study(MDRD)equation was used to estimate the patients,glomerular filtration rate(e-GFR),and the renal function abnormality rate in the patients was calculated[e-GFR<90ml/(min.1.73m2)].Meanwhile,univariate and multivariate Logistic regression analysis was used to analyze the high-risk factors.Bone mineral density was determined by dual-energy X-ray scanning.Results a total of 202 cases were collected in this study,and the overall rate of renal dysfunction was 18.3%.The abnormal rates of renal function in the groups of ADV,ADV/LAM,ETV and LAM were 20.6%,28.0%,11.8%and 9.1%,respectively.The incidence of renal dysfunction was statistically significant(x~2=2.267,P=0.040).The incidence of renal dysfunction in the group of ADV and the group of ADV/LAM was significantly higher than that in the group of LAM and ETV(P<0.05).The e-GFR abnormality rate of the group with high risk factors of renal injury was higher than that of the group without high risk factors of renal injury(x~2=2.723,P=0.031).152 cases without high risk factors of renal function injury were divided into two groups:group aged 60 years or older,and group aged less than 60 years.The rate of renal function abnormality in the two groups was 27.8%and 13.4%,respectively.The difference in e-GFR between the two groups was statistically significant(x~2=1.668,P=0.017).Multivariate Logistic regression analysis indicated that adefovir dipivoxil(OR=0.350,P=0.001),adefovir dipivoxil combined with lamivudine(OR=0.218,P=0.041),age(OR=0.957,P=0.022)and diabetes(OR=0.676,P=0.040)were significant risk factors for renal dysfunction.The overall prevalence of osteoporosis in the sample was 12.4%.The incidence of osteoporosis was 19.1%,22.0%,2.0%and0%,respectively,in the four groups of the ADV group,the ADV/LAM group,the ETV group and the LAM group(P<0.05).Conclusions long-term use of nucleoside(acid)class antiviral drugs may increase the risk of renal dysfunction in patients with chronic hepatitis B,especially those who take adefovir dipivoxil monotherapy or lamivudine combined therapy.Adefovir dipivoxil increases the risk of osteoporosis.