Chronic kidney disease progression in patients with chronic hepatitis B on tenofovir, entecavir, or no treatment
Chronic kidney disease progression in patients with chronic hepatitis B on tenofovir, entecavir, or no treatment
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DOI：
10.1111/apt.14945
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发表时间：
2018-11-01
影响因子：
7.6
通讯作者：
Wong, Vincent Wai-Sun
中科院分区：
文献类型：
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作者：
Wong, Grace Lai-Hung;Chan, Henry Lik-Yuen;Wong, Vincent Wai-Sun
背景资料：在涉及肾功能保留患者的临床试验中，富马酸替诺福韦二异丙酯（TDF）的使用与1%患者的轻度肾功能损害相关。目的：比较恩替卡韦（ETV）治疗、TDF-treated和untreated慢性B型肝炎患者的系列肾功能。方法：我们研究了某个地区慢性肾病（CKD）进展的风险-未接受治疗的慢性B型肝炎患者和接受ETV或TDF治疗的患者的广泛队列。估计肾小球滤过率（eGFR）由CKD流行病学协作组方程确定，并分为5个CKD阶段。CKD进展，定义为增加至少一个CKD阶段，治疗和未治疗patients.Results：倾向评分匹配后，2254 ETV治疗，2254 TDF治疗，和2254未治疗的患者被纳入分析。他们的平均基线eGFR分别为90.319.6、91.3 +/- 20.6和92.2 +/- 20.0 mL/min/1.73 m（2）。在平均2.4 ± 1.5年的随访期间，639例ETV治疗患者、706例TDF治疗患者和564例未治疗患者显示CKD进展1期。5年累积发病率CKD进展率（95%置信区间）在ETV治疗患者中为43%（40%-46%），在TDF治疗患者中为48%（45%-51%），在未治疗患者中为43%（39%-47%）（参考组）（P = 0.267，≥ 2期：未治疗组92例（4.1%），（4.2%）在ETV治疗队列中，结论：TDF的使用与少数患者的轻度肾损害有关;与未治疗的患者相比，接受ETV治疗的患者具有相似的风险。
Background: In clinical trials involving patients with preserved renal function, tenofovir disoproxil fumarate (TDF) use was associated with mild renal impairment in 1% of patients.Aim: To compare serial renal function of entecavir (ETV)-treated, TDF-treated, and untreated patients with chronic hepatitis B.Methods: We studied the risk of chronic kidney disease (CKD) progression in a territory-wide cohort of patients with chronic hepatitis B without treatment and of those on ETV or TDF treatment. Estimated glomerular filtration rate (eGFR) was determined by the CKD Epidemiology Collaboration equationand was classified into five CKD stages. CKD progression, defined as an increase of at least one CKD stage, was compared among treated and untreated patients.Results: After propensity score matching, 2254 ETV-treated, 2254 TDF-treated, and 2254 untreated patients were included in the analysis. Their mean baseline eGFR was 90.319.6, 91.3 +/- 20.6, and 92.2 +/- 20.0 mL/min/1.73 m(2), respectively. During a mean follow-up of 2.4 +/- 1.5 years, 639 ETV-treated, 706 TDF-treated, and 564 untreated patients exhibited CKD progression 1 stage. The 5-year cumulative incidence (95% confidence interval) of CKD progression was 43% (40%-46%) in ETV-treated, 48% (45%-51%) in TDF-treated, and 43% (39%-47%) in untreated patients (reference group), respectively (P = 0.267 and = 2 stages was 92 (4.1%) in the untreated cohort, 95 (4.2%) in the ETV-treated cohort, and 51 (2.3%) in the TDF-treated cohort.Conclusions: The use of TDF was associated with mild renal impairment in a minority of patients; those treated with ETV had a similar risk compared to untreated patients.