Effects Of Nonalcoholic Fatty Liver Disease On Renal Function In Patients With Chronic Hepatitis B

Objective:To investigate the effect of nonalcoholic fatty liver disease（NAFLD）on chronic hepatitis B（CHB）patients’renal function.Methods:Patients diagnosed with chronic hepatitis b without abnormal renal function from January 2016 to June 2017 were enrolled.Basic information and examination data of these patients were collected and renal function status was followed up for two years.Fibro Scan for assessing Controlled attenuation parameter（Controlled attenuation parameter,CAP）and Liver stiffness（Liver stiffness measurement,the LSM）.Propensity Score Matching（Propensity Score Matching,PSM）to match between groups.Modified of Diet in Renal Disease（MDRD）formula and the Chronic Kidney Disease Epidemiology Collaboration（CKD-EPI）formula in 2009 were used to estimate glomerular filtration rate to evaluate Renal function.Result:1.A total of 100 patients were enrolled,including 39 patients with CHB combined with NAFLD and 61 patients with CHB alone.The BMI,hypertension,diabetes,TG,LDH,UA and CAP of patients with CHB combined with NAFLD were higher than those of patients with CHB,and the difference was statistically significant（P<0.05）.A total of 58 patients were included in the study after PSM matched gender,age,BMI,hypertension and diabetes,among which 29 were CHB patients with NAFLD and 29were CHB patients alone.There was no statistically significant difference between the two groups in gender,age,BMI,hypertension,diabetes,antiviral therapy,ALT,AST,γ-GGT,ALP,TBIL,HDL,FBG,BUN,UA,HBe Ag,HBV-DNA and Scr（P>0.05）.2.After two years,5（17.2%）CHB patients with NAFLD had impaired renal function,while 8（27.6%）CHB patients had impaired renal function,with no statistically significant difference between the two groups（P>0.05）.Two years later,e GFR_CKD-EPIdecreased in both groups.In the CHB group with NAFLD,the decrease was 6.27（2.13,18.45）,with a decrease of 5.09%（2.02%,16.04%）,and in the CHB group,the decrease was 11.61（3.23,27.99）,with a decrease of 9.91%（2.68%,23.36%）.EGFR_MDRD decreased by 10.62（2.63,21.47）in the CHB group with NAFLD,with a decrease rate of 9.63%（2.91%,21.36%）,and by 17.02（2.65,37.99）in the CHB group,with a decrease rate of 14.38%（2.32%,31.30%）.However,there was no significant difference in the above indicators between the two groups（P>0.05）.3.Among the 58 patients,there were 29 cases（50%）in the non-fatty liver group（CHB patients）,mild fatty liver group,moderate fatty liver group,and severe fatty liver group,12 cases（20.69%）,11 cases（18.97%）,and 6 cases（10.34%）,respectively.After two years,there was no significant difference between the four groups in the e GFR decrease value and decrease amplitude（P>0.05）.4.Among the 58 patients,48 were in the F0-F1（no fibrosis-mild fibrosis）group,10were in the F2（moderate fibrosis）group,and there were no F3（severe fibrosis）or F4（cirrhosis）patients.There was no significant difference in e GFR decrease between the two groups（P>0.05）.Among the patients with CHB complicated with NAFLD,there were 25 cases in the F0-F1 group and 4 cases in the F2 group.Two years later,e GFR_CKD-EPI decreased in the F0-F1 group and F2 group（4.47±14.47 vs 23.84±5.38）.P=0.032),and the decrease was（4.06%±12.90%vs 19.40%±3.54%）.P=0.045);EGFR_MDRD decreased by 9.15（0.55,18.36）vs 29.56（19.82,39.04）,P=0.041;The decrease was 9.40%（6.60%,14.95%）vs 25.22%（18.99%,30.85%）,P=0.043,and the difference between the two groups was statistically significant（P<0.05）.Among the CHB patients,there were 22 cases in the F0-F1 group and 7 cases in the F2 group,and there was no statistically significant difference between the two groups in the e GFR decrease value and decrease amplitude（P>0.05）.5.In antiviral therapy,CHB patients in NAFLD group and CHB group had 18 cases respectively.EGFR in both groups decreased from two years ago.EGFR_CKD-EPIdecreased by 6.52（2.18,19.72）vs 12.74（6.29,21.11）in CHB patients with NAFLD and CHB patients with CHB,with a decrease of 7.53%±13.57%vs 14.66%±13.25%.There was no statistical difference between the two groups（P>0.05）.Among the patients with CHB associated with NAFLD,10 were in the entecavir group,8 were in the tenofovir group,and 11 were in the non-antiviral group.After two years,e GFR in all three groups was lower than before.EGFR_CKD-EPI in the entecavir group and the tenofovir group decreased to（1.08±10.41 vs 17.65±15.73）.P=0.017),the decrease was（0.88%±9.40%vs 15.83%±13.85%）.P=013),the difference between the two groups was statistically significant（P<0.05）.EGFR_CKD-EPI decreased to（17.65±15.73vs 3.13±14.82）in the tenofovir group and the non-antiviral group.P=0.035);The decrease was（15.83%±13.85%vs 2.43%±12.22%）.P=0.024),the difference between the two groups was statistically significant.EGFR_CKD-EPI decreased（1.08±10.41 vs3.13±14.82）between the entecavir group and the non-antiviral group,with a decrease rate of 0.88%±9.40%vs 2.43%±12.22%.There was no statistically significant difference between the two groups（P>0.05）.Among the CHB patients,there were 9cases in entecavir group,9 cases in tenofovir group,and 11 cases in the non-antiviral group.After two years,e GFR in all three groups decreased.EGFR_CKD-EPIdecreased11.61（7.97,13.34）vs 16.97（4.68,19.29）in the entecavir group and the tenofovir group.P=0.045,with a decrease of（12.60%±13.81%vs 14.73%±13.51%）;P=0.046),and the difference between the two groups was statistically significant（P<0.05）.EGFR_CKD-EPI decreased by 16.97（4.68,19.29）vs 3.96（0.34,13.05）in the tenofovir group and the non-antiviral group.P=0.034,with a decrease of 14.73%±13.51%vs12.10%±20.44%.P=0.039),and the difference between the two groups was statistically significant（P<0.05）.EGFR_CKD-EPI decreased by 11.61（7.97,13.34）vs3.96（0.34,13.05）in the entecavir group and the non-antiviral group,with a decrease of 12.60%±13.81%vs 12.10%±20.44%).There was no statistically significant difference between the two groups（P>0.05）.EGFR_CKD-EPI decreased(4.36（0.10,7.09）vs 16.97（4.68,19.29）in patients with CHB combined with NAFLD and CHB,with a decrease of 3.58%（-0.4%,6.31%）vs 13.14%（3.87%,17.57%）,and no statistically significant difference between the two groups（P>0.05）.In the antiviral therapy of tenofovir,e GFR_CKD-EPI decreased（17.65±15.7 vs 17.92±16.99）between the CHB group with NAFLD and the CHB group（15.84%±13.85%vs14.60%±13.82%）,and the difference between the two groups was not statistically significant（P>0.05）.6.Logistic regression analysis showed that patients with NAFLD,liver fibrosis and antiviral therapy were not independent risk factors for renal impairment in CHB patients（P>0.05）.Conclusion:1.Combined NAFLD did not increase the risk of renal impairment in CHB patients..2.The degree of hepatic fibrosis may influence the renal function of patients with CHB complicated with NAFLD.3.Tenofovir may affect the renal function of patients with CHB combined with NAFLD,and regular monitoring of renal function is recommended during antiviral therapy.