Adefovir, tenofovir and entecavir renal abnormality in chronic hepatitis B patients

Background: Renal dysfunction has been reported in chronic hepatitis B (CHB) patients treated with adefovir and tenofovir. However, few studies to date have measured estimated glomerular infiltration rate (eGFR) function in treatment of chronic hepatitis B with nucleos(t)ide analogs as well as reported eGFR function in long term treatment. Objective: To evaluate the incidence and magnitude of decrease in eGFR in patients with long-term treatment of CHB with adefovir, tenofovir, and entecavir. Materials and Methods: This is a retrospective cohort study of adult CHB patients who met treatment indication and treated with adefovir, tenofovir, or entecavir. Patients were excluded if there were co-infected with hepatitis C, hepatitis D, or HIV, decompensated cirrhosis at treatment initiation, baseline eGFR <50 ml/min. The patients were followed and compared cumulative incidence of renal dysfunction between the 3 study groups. Renal dysfunction was defined by decreased in eGFR >20% from baseline (MDRD 2 formula). Associated risk factors of renal dysfunction in long term treatment of CHB with oral nucleos(t)ide analogs were identified. Results: Of all 528 patients (180, 128, and 220 patients in adefovir, tenofovir, and entecavir groups, respectively), we found a significant difference in the incidence and magnitude of decrease in eGFR in patients treated with adefovir compared with tenofovir and entecavir. The incidences of renal dysfunction in the adefovir, tenofovir, and entecavir groups at 1 year follow-up were 18.9%, 7.8%, and 7.3%, respectively (p = 0.001). After adjustment for age, sex, hypertension, diabetes, and cirrhosis, treatment with adefovir 10 mg/day was found to be a significant predictor for decreasing in eGFR of >20% (OR 2.85, p<0.001). Conclusion: We observed greater incidences of renal dysfunction as measured by decrease in eGFR in patients treated with adefovir 10 mg/day when compared with tenofovir 300 mg/day and entecavir 0.5 mg/day.