Impact of nucleos(t)ide analogues on the estimated glomerular filtration rate in patients with chronic hepatitis B: a prospective cohort study in China

Chronic hepatitis B therapy with nucleos(t)ide analogues, particularly tenofovir or adefovir, may affect renal function. To date, there has not been a head-to-head controlled study to assess estimated glomerular filtration rate (eGFR) fluctuations in nucleos(t)ide-treated CHB patients. We aimed to evaluate the long-term effects of nucleos(t)ide on eGFR in Chinese patients with chronic hepatitis B. This prospective cohort study included 275 patients. Patient subgroups included those treated with lamivudine (n=50), adefovir (n=60), telbivudine (n=68) and entecavir (n=61); untreated patients (n=36) served as control. After an average follow-up duration of 23months, eGFR calculated by Cockcroft-Gault and Modification of Diet in Renal Disease formulas increased by 18.35mL/min and 19.34mL/min (P<0.0001) in the telbivudine group, respectively, and decreased by 10.95mL/min and 12.17mL/min (P=0.0001) in the adefovir group, respectively. Even if renal function was normal or mildly impaired at baseline, eGFR increased significantly more in the telbivudine group than in the other groups (P<0.001). More patients in the adefovir group (23%) had a 20% decrease in eGFR than the other groups (P<0.0001). More patients in the telbivudine group (31%) had a 20% increase in eGFR than the other groups (P<0.0001). In conclusion, prolonged telbivudine therapy resulted in improved eGFR, while adefovir therapy was associated with decreased eGFR. Lamivudine and entecavir therapy did not significantly influence eGFR.