By Shreeya Nanda
A South Korean research team has identified several clinical and medical factors associated with renal function decline in patients with chronic hepatitis B virus (HBV) infection treated with oral nucleos(t)ide analogues (NAs).
"These results suggest[...] the need for a thorough evaluation of both renal function and risk factors before and during treatment with oral antiviral agents", write Hye Ryoun Jang and fellow investigators, from Sungkyunkwan University School of Medicine in Seoul.
Over a follow-up of 23 months, 16.9% of 4178 NA-treated Asian patients experienced renal function decline, defined as a reduction in estimated glomerular filtration rate (eGFR) of more than 25% from baseline with no recovery until the end of follow-up.
And 12.8% of 3175 patients followed up for at least 1 year developed rapid chronic kidney disease (CKD) progression, defined as an annual decrease in eGFR of more than 5 mL/min per 1.73 m2.
Multivariate analysis showed that age, presence of diabetes mellitus, a history of kidney transplantation, underlying CKD and concomitant use of diuretic agents were significant risk factors for both renal function decline and rapid CKD progression during antiviral therapy, with hazard ratios (HRs) ranging from 1.03 to 3.47 (p values of 0.001 and below) and odds ratios (OR) from 1.04 to 16.91 (p<0.001 for all), respectively.
In addition, presence of hypertension and a history of liver transplantation significantly increased the risk of renal function decline in patients undergoing NA treatment by a respective 1.42- (p=0.002) and 2.19-fold (p<0.001).
Jang et al also evaluated the relationship between antiviral agents and renal impairment. Relative to lamivudine, clevudine treatment not only significantly protected against renal function decline (HR=0.36, p=0.004) but also against chronic CKD progression (OR=0.17, p=0.001).
And during the course of the study, eGFR rose by 1.5 mL/min per 1.73 m2 annually in clevudine-treated patients and by 3.9 mL/min per 1.73 m2 annually in those given telbivudine, while eGFR declined in participants who received adefovir dipivoxil, entecavir or tenofovir disoproxil fumarate.
However, on the whole the nephrotoxicity of adefovir and tenofovir was not significant, say the researchers in Medicine, adding that despite the renoprotective effects of clevudine, "a high frequency of resistance and associated myopathy make it difficult for clevudine to be the first-line therapy".
Furthermore, they believe that the telbivudine findings need to be verified in a larger cohort as only a small proportion of patients in their chart review received this agent.
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