Is Tenofovir Disoproxil Nephrotoxic in All Patients? Long-Term Effects
of Tenofovir and Entecavir on Renal Functions in an Endemic Area.
Abstract
Introduction: Hepatit B virus (HBV) is one of the main causes of liver
related morbidity and mortality in worldwide. This condition is also a
significant healthcare problem in Turkey. Entecavir (ETV) and tenofovir
(TDF) are potent nucleos(t)ide analogues (NAs) recommended for the
treatment of chronic HBV (CHB) infection. As the data on this topic is
limited, we aimed to study the association of NAs and nephrotoxicity in
our CHB cohort. Method: Between the January 2011 and February 2016,
there were 294 patients who had been treated with TDF (n=194) and ETV
(n=100). Clinical and laboratory data such as demographics, serological
markers for HBV, pathology scores and routine blood tests were recorded
from the charts. Glomerular filtration rate (GFR) was calculated by
using the Modification of Diet in Renal Disease (MDRD) method. Kidney
function tests were assessed at baseline and follow-up visits. Results:
There were 294 patients in the total group. The mean age was 32±11
years, 66% (n=194) of the group was male. The mean follow-up period was
66±18 months. Age and sex distributions and baseline assessments
including liver function tests, creatinine, GFR, HBV DNA values and
pathology scores (HAI and fibrosis) were similar between TDF (n=194) and
ETV (n=100) groups. Creatinin and GFR assessed at the last visit were
0.81±0.01 g/dl and 102.94+19.78 ml/min for TDF and 0.81±0.013 g/dl and
104.65±19.05 ml/min for ETV. These values were not significant between
the both treatment groups. In terms of nephrotoxicity, none of the
patients had significant changes in terms of creatinine and GFR that may
require dose adjustment. Conclusion: Herein we showed that the use of
both drugs led to a decrease in GFR that was not clinically important in
chronic hepatitis B patients with normal baseline renal tests and
without co-morbidity. Key words: Entecavir, Tenofovir, GFR, Chronic
hepatitis B