应用核苷(酸)类治疗慢性乙型肝炎患者早期肾功能的变化*

doi:10.3969/j.issn.1672-5069.2022.03.012

Abstract

Abstract: Objective The aim of this study was to observe the early impact of first-line nucleos(t)ide analogs (NAs), e.g. entecavir(ETV), tenofovir disoproxil fumarate(TDF) and tenofovir alafenamide(TAF), on renal function tests in patients with chronic hepatitis B (CHB). Methods 68 patients with CHB were encountered in our Hospital between September 2019 and May 2021, and out of them, 22 patients received ETV, 26 patients received TDF and 20 patients took TAF therapy. All the patients were followed-up for six months. Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), urine retinol-binding protein (RBP), urine cystatin C (Cys-C), urine N.acetyl.β.D.glucosidase (NAG), urine α1-microglobulin(α1-MG) and urine β2-microglobulin (β2-MG) levels were observed. Results At the end of 24±2 weeks of treatment, serum alanine aminotransferase levels in ETV-treated, TDF-treated and TAF-treated patients were (33.2±5.4)U/L, (31.4±8.2)U/L and (32.7±6.1)U/L (P>0.05), and serum aspartate aminotransferase levels in the three groups were (23.8±7.6)U/L, (24.3±9.2) U/L and (22.9±7.8)U/L, not significantly different among them (P>0.05); serum HBsAg levels in the three groups were (3.0±0.7) lgIU/ml, (2.9±0.5)lgIU/ml and (2.8±0.6)lgIU/ml, and serum HBV DNA loads in the three groups were (1.9±0.6) lgIU/mL, (1.8±0.5) lgIU/mL and (1.6±0.7) lgIU/mL, not significantly different among them (P>0.05); there were no statistically significantly differences as respect to sCr, eGFR, urinary RBP, urinary Cys-C, urinary NAG and urinary β2-MG levels in the three groups (P>0.05), while urine α1-MG level in TDF-treated patients was (1.4±0.9)ln mg/L, significantly higher than (0.7±1.1) ln mg/L in ETV-treated or (0.7±0.9)ln mg/L in TAF-treated patients (P<0.05). Conclusion Our findings suggests that ETV, TDF and TAF have the same antiviral efficacy in patients with CHB, but the renal function tests should be specially surveyed in patients with TDF treatment.

Key words: Hepatitis B, Tenofovir disoproxil fumarate, Tenofovir alafenamide, Urinary α1-microglobulin, Safety, Therapy

Jiang Yuemeng, Ma Yuqi, Kan Chunming, et al. Early impact of nucleos(t)ide analogs on renal function tests in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2022, 25(3): 351-354.

References

[1] Wang FS, Fan JG, Zhang Z, et al. The global burden of liver disease: the major impact of China. Hepatology,2014,60(6):2099-108.
[2] 中华医学会.慢性乙型肝炎防治指南(2019年版).实用肝脏病杂志,2020,23(1):9-32.
[3] Mak LY, Cruz-Ramón V, Chinchilla-López P, et al. Global epidemiology, prevention, andmanagement of hepatocellular carcinoma. Am Soc Clin Oncol Educ Book,2018,23:38:262-279.
[4] Liaw YF. Reversal of cirrhosis: an achievable goal of hepatitis B antiviral therapy. J Hepatol,2013,59(4):880-881.
[5] Griffin BR, Faubel S, Edelstein CL. Biomarkers of drug-induced kidney toxicity. Ther Drug Monit,2019,41(2):213-226.
[6] Aguiar P, Azevedo O, Pinto R, et al. New biomarkers defining a novel early stage of fabry nephropathy: a diagnostic test study. Mol Genet Metab,2017,21(2):162-169.
[7] Lee WA, He GX, Eisenberg E, et al. Selective intracellular activation of a novel prodrug of the human immunodeficiency virus reverse transcriptase inhibitor tenofovir leads to preferential distribution and accumulation in lymphatic tissue. Antimicrob Agents Chemother,2005,49(5):1898-906.
[8] Zhu YF, Tan YF, Xu X, et al. Gamma-glutamyl transpeptidase-to-platelet ratio and the fibrosis-4 index in predicting hepatitis B virus-related hepatocellular carcinoma development in elderly chronic hepatitis B patients in China: A single-center retrospective study. Medicine (Baltimore), 2019,98(50):e18319.
[9] Murakami E, Wang T, Park Y, et al. Implications of efficient hepatic delivery by tenofovir alafenamide (GS-7340) for hepatitis B virus therapy. Antimicrob Agents Chemother,2015,59(6):3563-3569.
[10] Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised,double-blind,phase 3,non-inferiority trial. Lancet Gastroenterol Hepatol,2016,1(3):196-206.
[11] Chan HL, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol,2016,1(3):185-195.
[12] Ishiwata S, Matsue Y, Nakamura Y, et al. Clinical and prognostic values of urinary alpha1-microglobulin as a tubular marker in acute heart failure. Int J Cardiol,2021,338:115-120.
[13] Tun-Yhong W, Chinpaisal C, Pamonsinlapatham P, et al. Tenofovir disoproxil fumarate is a new substrate of ATP-binding cassette subfamily C member 11. Antimicrob Agents Chemother,2017,61(4):e01725-1726.
[14] Milián L, Peris JE, Gandía P, et al. Tenofovir-induced toxicity in renal proximal tubular epithelial cells: involvement of mitochondria. AIDS,2017,31(12):1679-1684.
[15] Jang E, Lee JK, Inn KS, et al. Renal dysfunction andtubulopathy induced by high-dose tenofovir disoproxil fumarate in C57BL/6 mice. Healthcare (Basel), 2020,8(4):417.
[16] Karris M. Short communication: resolution of tenofovir disoproxil fumarate induced fanconi syndrome with switch to tenofovir alafenamide fumarate in a HIV － 1 and hepatitis B coinfected patient. AIDS Res Hum Retroviruses,2017,33 (7):718－722.
[17] Deiva A, Jayaprakash V, Jose N, et al. Acute kidney injury in a patient treated with tenofovir alafenamide fumarate for hepatitis B virus infection. Saudi J Kidney Dis Transpl,2021,32(2):592-594.
[18] Agarwal K, Fung SK, Nguyen TT, et al. Twenty-eight-day safety, antiviral activity, and pharmacokinetics of tenofovir alafenamide for treatment of chronic hepatitis B infection,J Hepatol,2015,62(3):533-540.
[19] Surial B, Béguelin C, Chave JP, et al. Switching from TDF to TAF in HIV/HBV-coinfected individuals with renal dysfunction-A prospective cohort study. J Acquir Immune Defic Syndr,2020,85(2):227-232.
[20] Farag MS, Fung S, Tam E, et al. Effectiveness and renal safety of tenofovir alafenamide fumarate among chronic hepatitis B patients: real-world study. J Viral Hepat,2021,28(6):942-950.
[21] Nishijima T, Shimbo T, Komatsu H, et al. Urinary beta-2 microglobulin and alpha-1 microglobulin are useful screening markers for tenofovir-induced kidney tubulopathy in patients with HIV-1 infection: a diagnostic accuracy study. J Infect Chemother,2013,19(5):850-857.
[22] Zhang WR, Scherzer R, Estrella MM, et al. Tenofovir disoproxil fumarate initiation and changes in urinary biomarker concentrations among HIV-infected men and women. AIDS,2019,33(4):723-733.
[23] Kang J, Liu J, Ding H, et al. Urine alpha1-microglobulin is a better marker for early tubular dysfunction than beta2-microglobulin among tenofovir-exposed human immunodeficiency virus-infected men who have sex with men. Braz J Infect Dis,2015,19(4):410-416.
[24] Lampertico P, Buti M, Fung S, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patients with chronic hepatitis B: a randomised, double-blind, phase 3, multicentre non-inferiority study. Lancet Gastroenterol Hepatol,2020,5(5):441-453.
[25] Lee BT, Chang M, Lim C, et al. Bone and renal safety profile at 72 weeks after switching to tenofovir alafenamide in chronic hepatitis B patients. JGH Open,2020,5(2):258-263.
[26] Byun KS, Choi J, Kim JH, et al. Tenofovir alafenamide for drug-resistant hepatitis B: a randomized trial for switching from tenofovir disoproxil fumarate. Clin Gastroenterol Hepatol,2022,20(2):427-437.

Early impact of nucleos(t)ide analogs on renal function tests in patients with chronic hepatitis B

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	He Yajuan, Wang Fei, Yao Naijuan, et al. Hepatitis B whole x gene promotes inflammation reaction of hepatic stellate cells and triggers hepatocyte apoptosis in vitro [J]. Journal of Practical Hepatology, 2022, 25(3): 323-326.
[2]	Huang Junrong, Wu Changru, Wu Jianlin. Short-term observation of entecavir and magnesium isoglycyrrhizinate in treatment of patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2022, 25(3): 327-330.
[3]	Zou Donghua, Mi Jianwei, Li Yuling, et al. Rescued therapy of patients with chronic hepatitis B and rtA181V/T mutation by adefovir dipivoxiland entecavir or tenofovir combination [J]. Journal of Practical Hepatology, 2022, 25(3): 331-334.
[4]	Luo Ke, Ding Li, Liu Mei. Serum miR-21 and miR-148b levels in patients with chronic hepatitis B and their predictive value for liver tissue inflammation grading and fibrosis staging [J]. Journal of Practical Hepatology, 2022, 25(3): 335-338.
[5]	Wang Guangli, Xu Huan, Dong Dandan, et al. Entecavir resistance gene mutation in nucleosi(t)de-treated patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2022, 25(3): 339-342.
[6]	Yan Zhaolan, Zu Hongmei, Cai Changxia, et al. Clinical features of chronic hepatitis B viral infected individuals with low serum alanine aminotransferase levels: clues for early liver biopsies [J]. Journal of Practical Hepatology, 2022, 25(3): 343-346.
[7]	Li Chunhua, Li Zhongxin, Zhang Chunlei, et al. Diagnostic performance of serum FGF-21, PDGF-BB and FBRS levels on significant liver fibrosis in patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2022, 25(3): 347-350.
[8]	Chai Xiaozhe, Zhu Xiafeng, Luo Chenglin, et al. Comparison of virologic response in patients with chronic hepatitis C and hepatitis C viral genotype 1b infection receiving pan-genotype or precise genotype-specific direct antiviral agent therapy [J]. Journal of Practical Hepatology, 2022, 25(3): 355-358.
[9]	Hu Chunxia, Yang Jiaonan, Zhang Fengxiao et al. Efficacy and safety of glecaprevir/pibrentasvir therapy in the treatment of patients with chronic hepatitis C and genotype 1b infection [J]. Journal of Practical Hepatology, 2022, 25(3): 359-362.
[10]	Chen Yejing, Lu Qingping, Gu Shaoying. Comparison of therapeutic efficacy of magnesium isoglycyrrhizinate and compound glycyrrhizin monoamine in treatment of patients with drug-induced liver injury [J]. Journal of Practical Hepatology, 2022, 25(3): 371-374.
[11]	Yang Haihua, Zhou Cong, Shen Guoqiang, et al. Clinical feature of tigecycline-induced liver injuries in 134 elderly patients with infection and underlying diseases [J]. Journal of Practical Hepatology, 2022, 25(3): 375-378.
[12]	Wang Shisong, Lin Huixiong, Zhang Taisheng, et al. Short-term observation of metformin and dapagliflozin combination therapy in the treatment of patients with T2DM and NAFLD and their impact on serum dipeptidyl peptidase 4 and C-peptide levels [J]. Journal of Practical Hepatology, 2022, 25(3): 379-382.
[13]	Shen Yanglin, Tan Keping, You Zhonglan, et al. Short-term efficacy of sequential plasma exchange and dual plasma molecular adsorption system combination in treatment of patients with HBV-ACLF [J]. Journal of Practical Hepatology, 2022, 25(3): 387-390.
[14]	Sun Yanan, Zeng Qinghuan, Liu Yuanzhi, et al. Influencing factors for prognosis of patients with acute-on-chronic liver failure and moderate or severe esophageal varices [J]. Journal of Practical Hepatology, 2022, 25(3): 391-394.
[15]	Zhan Huizhen, Du Yaqin, Wang Songjiao. Seven-day observation of concentrated ascites reinfusion and terlipressin combination therapy in the treatment of patients with liver cirrhosis and refractory ascites [J]. Journal of Practical Hepatology, 2022, 25(3): 395-398.