Effect of HBV polymerase inhibitors on renal function in patients with chronic hepatitis B.

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J Hepatol. 2011 May 19. [Epub ahead of print]

Effect of HBV polymerase inhibitors on renal function in patients with chronic

hepatitis B.

Mauss S, Berger F, Filmann N, Hueppe D, Henke J, Hegener P, Athmann C, Schmutz

G, Herrmann E.

Source

Center for HIV and Hepatogastroenterology, Duesseldorf, Germany.

Abstract

BACKGROUND AND AIMS:

Therapy of chronic hepatitis B with HBV-polymerase inhibitors, in particular

tenofovir or adefovir, may affect renal function. To assess renal function more

accurately in the normal range, we used the recently validated, Chronic Kidney

Disease Epidemiology Collaboration (CKD-EPI) formula to calculate the estimated

glomerular filtration rate (eGFR).

METHODS:

Patient subgroups included: Patients with HBV-monoinfection treated with

lamivudine (n=36), adefovir (n=32), entecavir (n=32) or tenofovir (n=37).

HBsAg-positive untreated patients (n=60) served as control. For comparison

HIV-monoinfected patients treated with tenofovir (n=120) or zidovudine (n=52)

based antiretroviral therapy and antiretroviral naive patients (n=109) were

assessed. CKD-EPI equation was used to calculate eGFR. In a more sensitive

approach, we modelled the individual change in eGFR over time with linear mixed

effects models (LME).

RESULTS:

Yearly predicted median changes in individual eGFR according to the LME model

were: HBV untreated -2.05 ml/min, HBV lamivudine -0.92 ml/min, HBV adefovir

-1.02 ml/min, HBV entecavir -1.00 ml/min and HBV tenofovir -0.92 ml/min (p<0.01

for HBV untreated vs. HBV treated). In HIV-monoinfected patients: HIV untreated

-0.62 ml/min, HIV treated with tenofovir -2.64 ml/min, HIV treated with

zidovudine -1.0 ml/min (p=0.017 for tenofovir vs. no treatment, p<0.001 for

tenofovir vs. zidovudine).

CONCLUSIONS:

Therapy of HBV infection irrespective of medication seems to result in a milder

decrease of renal function. In contrast tenofovir as part of HIV combination

therapy seems to impair renal function in this Caucasian population.

Copyright © 2011. Published by Elsevier B.V.

PMID: 21703180 [PubMed - as supplied by publisher]