effects of nucleos(t)ide analogues on estimated glomerular filtration rate and serum creatinine level in patients with chronic hepatitis b

ObjectiveTo investigate the effects of nucleos(t)ide analogues (NAs) on the estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) in patients with chronic hepatitis B (CHB). MethodsA total of 184 patients with CHB who visited and were hospitalized in the Second Affiliated Hospital of Dalian Medical University from September 2010 to September 2014 were enrolled and divided into adefovir (ADV) group (58 patients), telbivudine (LDT) group (62 patients), and entecavir (ETV) group (64 patients), according to the NAs administered. The course of treatment was 104 weeks for all groups. The changes in eGFR and Scr level in each group after treatment were evaluated. The chi-square test was applied for comparison of categorical data between groups; the Wilcoxon rank sum test was applied for comparison of continuous data before and after treatment within one group, and Kruskal-Wallis H rank sum test was applied for comparison between groups. ResultsIn the ETV group, there were no significant changes in Scr and eGFR after 52 and 104 weeks of treatment (all P＞0.05); in the ADV group, there was a significant increase in Scr level and a significant reduction in eGFR after 52 and 104 weeks of treatment (Z=-3.020, -3.456, -4.623, and -4.831, P=0.018, 0.008, 0.004, and ＜0001, respectively); in the LDT group, there was a significant reduction in Scr level and a significant increase in eGFR after 52 and 104 weeks of treatment (Z=-5596, -5.687, -5.335, and -5.162, P=0.007, 0.003, 0.002, and ＜0.001, respectively). After 104 weeks of treatment, the distribution of eGFR showed a significant difference between the ADV group and the LDT group (χ2=21.039, P＜0.001); in the LDT group, 77.78% (7/9) of all the patients achieved eGFR ≥90 ml·min-1·1.73 m-2, and in the ADV group, 23.81%(10/42) of all the patients achieved eGFR ＜90 ml·min-1·1.73 m-2. ConclusionDuring the treatment, LDT can increase eGFR and improve renal function significantly,while ADV may reduce eGFR, with potential nephrotoxicity. During the treatment for patients with CHB, eGFR may reflect renal injury much earlier than Scr. The mechanisms of action of LDT in increasing eGFR and protecting renal function await further investigation.