Hepatitis B and renal function: A matched study comparing non‐hepatitis B, untreated, treated and cirrhotic hepatitis patients

Abstract

Background & Aim Renal impairment is associated with chronic hepatitis B (CHB). To overcome prior study design differences, we used propensity score matching to balance the non‐CHB and CHB cohorts and generalized linear modelling (GLM, models using probit and logit linking functions for complex models) to evaluate the effect of CHB, treatment and cirrhosis on renal function. Methods A retrospective cohort (1996‐2017) from one U.S. university medical centre. Included patients had ≥12 months of serial creatinine laboratories and a baseline estimated glomerular filtration rate (eGFR, by the Modification of Diet in Renal Disease Study equation) ≥60 mL/min/1.73 m2. Propensity score matching was performed using age, sex, ethnicity, diabetes, hypertension and baseline eGFR. GLM was performed to generate adjusted mean eGFR over time. Results Adjusted mean eGFR was significantly higher for non‐CHB vs. untreated CHB patients (eGFR 87.4 vs. 85.6, P= 0.004, n = 580, median follow‐up = 82 months). A significant difference in adjusted mean eGFR between untreated vs. entecavir (ETV)‐treated CHB patients (eGFR 85.1 vs. 83.5, P= 0.02, n = 340, median follow‐up = 70 months) was found among non‐cirrhotic CHB. Among treated CHB, there was no difference in adjusted mean eGFR between non‐cirrhotic vs. cirrhotic patients (eGFR 77.0 vs. 76.5; P= 0.66, n = 112, median follow‐up = 58 months). Conclusion After PSM and GLM, the significant predictors for worsening renal function were age, hypertension and diabetes mellitus but not CHB, ETV or cirrhosis. However, given small sample size, data regarding the use of ETV in patients with cirrhosis should be interpreted with caution and requires additional investigation.

Nonliver Comorbidities in Patients With Chronic Hepatitis B

“…In our work comparing patients with CHB who received TDF, received ETV, or remained untreated, we did not find a statistically significant difference between groups in the incidence of osteopenia/osteoporosis . These findings have been corroborated by several other studies …”

“…37 These findings have been corroborated by several other studies. 10,[38][39][40][41][42] In the meantime, TAF was recently approved for treatment of CHB because it was found to be noninferior to TDF in terms of efficacy in two large registration clinical trials. 35,43,44 Overall, when TAF was compared with TDF, TAF was associated with a milder decrease in both bone mineral density and estimated glomerular filtration rate (eGFR) after a follow-up of 48 weeks.…”

Association between serum Cystatin C and renal injury in patients with chronic hepatitis B

“…[ 1 ] Studies have reported that patients with chronic hepatitis B (CHB) and liver cirrhosis have different degrees of renal injury as the disease progresses. [ 2 , 3 ] A variety of mechanisms can induce renal function injury in patients with CHB. [ 4 ] Studies have reported that, after the hemodynamic changes, renal injury will further reduce the glomerular filtration rate (GFR) and therefore increase the mortality rate.…”

Treatment and Renal Outcomes Up to 96 Weeks After Tenofovir Alafenamide Switch From Tenofovir Disoproxil Fumarate in Routine Practice

“…(5) As such, suppression of HBV remains one of the pillars of CHB management. (6) Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been the mainstays of therapy over the past decade; however, each is associated with side effects including renal impairment and bone loss (7,8) with TDF and potential viral resistance with ETV, especially in those with a history of resistance to the older nucleoside analogue lamivudine. (9) More recently, an HBV viral suppression drug was approved, tenofovir alafenamide (TAF).…”