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

Objective To investigate the effects of nucleos( t) ide analogues( NAs) on the estimated glomerular filtration rate( e GFR) and serum creatinine( Scr) in patients with chronic hepatitis B( CHB). Methods A 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 e GFR 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. Results In the ETV group,there were no significant changes in Scr and e GFR 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 e GFR 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 e GFR 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 e GFR 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 e GFR ≥90 ml·min- 1·1. 73 m- 2,and in the ADV group,23. 81%( 10 /42) of all the patients achieved e GFR < 90 ml·min- 1·1.73 m- 2. Conclusion During the treatment,LDT can increase e GFR and improve renal function significantly,while ADV may reduce e GFR,with potential nephrotoxicity. During the treatment for patients with CHB,e GFR may reflect renal injury much earlier than Scr. The mechanisms of action of LDT in increasing e GFR and protecting renal function await further investigation.