Frequency and Risk Factors of Renal Impairment During Long-term Adefovir Dipivoxil Treatment in Chronic Hepatitis B Patients

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http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06852.x/abstract;jse\

ssionid=039C258033F0DACD407C0B04114293B1.d02t02

Frequency and Risk Factors of Renal Impairment During Long-term Adefovir

Dipivoxil Treatment in Chronic Hepatitis B Patients

Yu Jin Kim, Hyun Chin Cho, Dong Hyun Sinn, Geum-Youn Gwak, Moon Seok Choi, Kwang

Cheol Koh, Seung Woon Paik, Byung Chul Yoo, Joon Hyeok Lee

DOI: 10.1111/j.1440-1746.2011.06852.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background and Aim

There is insufficient data on renal safety during long-term adefovir dipivoxil

(ADV) treatment. We aimed to elucidate the incidence and risk factors of renal

impairment in chronic hepatitis B (CHB) patients treated with ADV.

Methods

We retrospectively enrolled 687 CHB patients (51.4% with compensated cirrhosis)

treated with ADV alone (18.2%) or in combination with lamivudine (LAM, 81.8%)

for more than 12 months. Renal function was measured using estimated glomerular

filtration rate (eGFR), and renal dysfunction was defined as mild (20-30%

decrease), moderate (30-50%), or severe (more than 50%).

Results

During the median treatment duration of 27 months, 72 patients (10.5%) developed

renal impairment, which was mild in 77.8% of cases, moderate in 20.8% of cases,

and severe in one patient. The cumulative incidence of renal impairment at 1, 3,

and 5 years was 2.6%, 14.8%, and 34.7%, respectively. Modification of the dosing

interval or discontinuation of ADV was required in seven and three patients,

respectively, and none of them showed further decline of eGFR. Although

univariate analysis revealed age, the number of exposure to radio-contrast dye,

liver cirrhosis, and hepatocellular carcinoma as risk factors of renal

impairment, age was the only significant risk factor identified in multivariate

analysis [ odds ratio = 1.048, 95% confidence interval = 1.019–1.076, p= 0.001).

Conclusions

Renal impairment in long-term ADV users was relatively frequent, but serious

renal toxicity was rare and all cases were safely managed. Careful monitoring of

renal function is required, especially in older patients.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06852.x/abstract;jse\

ssionid=039C258033F0DACD407C0B04114293B1.d02t02

Frequency and Risk Factors of Renal Impairment During Long-term Adefovir

Dipivoxil Treatment in Chronic Hepatitis B Patients

Yu Jin Kim, Hyun Chin Cho, Dong Hyun Sinn, Geum-Youn Gwak, Moon Seok Choi, Kwang

Cheol Koh, Seung Woon Paik, Byung Chul Yoo, Joon Hyeok Lee

DOI: 10.1111/j.1440-1746.2011.06852.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background and Aim

There is insufficient data on renal safety during long-term adefovir dipivoxil

(ADV) treatment. We aimed to elucidate the incidence and risk factors of renal

impairment in chronic hepatitis B (CHB) patients treated with ADV.

Methods

We retrospectively enrolled 687 CHB patients (51.4% with compensated cirrhosis)

treated with ADV alone (18.2%) or in combination with lamivudine (LAM, 81.8%)

for more than 12 months. Renal function was measured using estimated glomerular

filtration rate (eGFR), and renal dysfunction was defined as mild (20-30%

decrease), moderate (30-50%), or severe (more than 50%).

Results

During the median treatment duration of 27 months, 72 patients (10.5%) developed

renal impairment, which was mild in 77.8% of cases, moderate in 20.8% of cases,

and severe in one patient. The cumulative incidence of renal impairment at 1, 3,

and 5 years was 2.6%, 14.8%, and 34.7%, respectively. Modification of the dosing

interval or discontinuation of ADV was required in seven and three patients,

respectively, and none of them showed further decline of eGFR. Although

univariate analysis revealed age, the number of exposure to radio-contrast dye,

liver cirrhosis, and hepatocellular carcinoma as risk factors of renal

impairment, age was the only significant risk factor identified in multivariate

analysis [ odds ratio = 1.048, 95% confidence interval = 1.019–1.076, p= 0.001).

Conclusions

Renal impairment in long-term ADV users was relatively frequent, but serious

renal toxicity was rare and all cases were safely managed. Careful monitoring of

renal function is required, especially in older patients.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06852.x/abstract;jse\

ssionid=039C258033F0DACD407C0B04114293B1.d02t02

Frequency and Risk Factors of Renal Impairment During Long-term Adefovir

Dipivoxil Treatment in Chronic Hepatitis B Patients

Yu Jin Kim, Hyun Chin Cho, Dong Hyun Sinn, Geum-Youn Gwak, Moon Seok Choi, Kwang

Cheol Koh, Seung Woon Paik, Byung Chul Yoo, Joon Hyeok Lee

DOI: 10.1111/j.1440-1746.2011.06852.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background and Aim

There is insufficient data on renal safety during long-term adefovir dipivoxil

(ADV) treatment. We aimed to elucidate the incidence and risk factors of renal

impairment in chronic hepatitis B (CHB) patients treated with ADV.

Methods

We retrospectively enrolled 687 CHB patients (51.4% with compensated cirrhosis)

treated with ADV alone (18.2%) or in combination with lamivudine (LAM, 81.8%)

for more than 12 months. Renal function was measured using estimated glomerular

filtration rate (eGFR), and renal dysfunction was defined as mild (20-30%

decrease), moderate (30-50%), or severe (more than 50%).

Results

During the median treatment duration of 27 months, 72 patients (10.5%) developed

renal impairment, which was mild in 77.8% of cases, moderate in 20.8% of cases,

and severe in one patient. The cumulative incidence of renal impairment at 1, 3,

and 5 years was 2.6%, 14.8%, and 34.7%, respectively. Modification of the dosing

interval or discontinuation of ADV was required in seven and three patients,

respectively, and none of them showed further decline of eGFR. Although

univariate analysis revealed age, the number of exposure to radio-contrast dye,

liver cirrhosis, and hepatocellular carcinoma as risk factors of renal

impairment, age was the only significant risk factor identified in multivariate

analysis [ odds ratio = 1.048, 95% confidence interval = 1.019–1.076, p= 0.001).

Conclusions

Renal impairment in long-term ADV users was relatively frequent, but serious

renal toxicity was rare and all cases were safely managed. Careful monitoring of

renal function is required, especially in older patients.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06852.x/abstract;jse\

ssionid=039C258033F0DACD407C0B04114293B1.d02t02

Frequency and Risk Factors of Renal Impairment During Long-term Adefovir

Dipivoxil Treatment in Chronic Hepatitis B Patients

Yu Jin Kim, Hyun Chin Cho, Dong Hyun Sinn, Geum-Youn Gwak, Moon Seok Choi, Kwang

Cheol Koh, Seung Woon Paik, Byung Chul Yoo, Joon Hyeok Lee

DOI: 10.1111/j.1440-1746.2011.06852.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background and Aim

There is insufficient data on renal safety during long-term adefovir dipivoxil

(ADV) treatment. We aimed to elucidate the incidence and risk factors of renal

impairment in chronic hepatitis B (CHB) patients treated with ADV.

Methods

We retrospectively enrolled 687 CHB patients (51.4% with compensated cirrhosis)

treated with ADV alone (18.2%) or in combination with lamivudine (LAM, 81.8%)

for more than 12 months. Renal function was measured using estimated glomerular

filtration rate (eGFR), and renal dysfunction was defined as mild (20-30%

decrease), moderate (30-50%), or severe (more than 50%).

Results

During the median treatment duration of 27 months, 72 patients (10.5%) developed

renal impairment, which was mild in 77.8% of cases, moderate in 20.8% of cases,

and severe in one patient. The cumulative incidence of renal impairment at 1, 3,

and 5 years was 2.6%, 14.8%, and 34.7%, respectively. Modification of the dosing

interval or discontinuation of ADV was required in seven and three patients,

respectively, and none of them showed further decline of eGFR. Although

univariate analysis revealed age, the number of exposure to radio-contrast dye,

liver cirrhosis, and hepatocellular carcinoma as risk factors of renal

impairment, age was the only significant risk factor identified in multivariate

analysis [ odds ratio = 1.048, 95% confidence interval = 1.019–1.076, p= 0.001).

Conclusions

Renal impairment in long-term ADV users was relatively frequent, but serious

renal toxicity was rare and all cases were safely managed. Careful monitoring of

renal function is required, especially in older patients.