The Clinical Research Of Renal Function In The Patients With Adefovir Dipivoxil Related Renal Dysfunction Switching To Telbivudine Or Entecavir

Objective:To observe the effect of renal function about adefovir dipivoxil(ADV)in anti-hepatitis B virus therapy,analyze its risk factors,and evaluate the renal function improvement in patients of ADV related renal damage after switching to telbivudine(LDT)monotherapy or combination therapy and entecavir(ETV)monotherapy.Methods:Our retrospective study incorporated 1007 inpatients and outpatients both with chronic hepatitis B or cirrhosis and treatment time longer than 2years.According to the inclusion criteria,235 patients were excluded,ADV group included 411 patients with adefovir dipivoxil treatment,and ETV group consisted of 361 patients with entecavir treatment in this research.Comparing to the baseline levels of serum creatine(Scr),creatine clearance(Ccr)and estimated glomerular filtration rate(e GFR)between the two groups,t-text method was used to analyze the differences in the renal damage,and the Kaplan-Meier method was applied to evaluate the percent of patients with renal function maintaining receiving ADV therapy.Using COX regression analysis to find the risk factors associated with renal impairment.To the renal impairment patients of ADV group,chi-square analysis was used to asses the effect of renal improvement and differences after switching to LDT monotherapy or combination therapy and ETV monotherapy.Result:Patients of two groups were not matched for age,sex,and weight completely,but well-matched with baseline Scr,Ccr,e GFR.The difference of e GFR decreasing between ADV group(92.24 ± 25.84 m L.min-1.(1.73m2)-1)and ETV group(113.14 ± 28.83 m L.min-1.(1.73 m2)-1)was obvious.The incidence density for renal dysfunction was 3.17 cases per100 patients-years in ADV group compared with 1.64 cases per 100patients-years.On Cox proportional hazard analysis,ADV was a significant predictor of renal dysfunction(hazard rate [HR] 4.33,P < 0.01).There were also significant trends for hypertension(HR 5.24,P < 0.01),diabetes(HR 14.25,P < 0.01),HBe Ag positive(HR 1.01,P = 0.01),renal impairment(HR 1.01,P = 0.01)at baseline.There were no significant differences in renal function improvement after treatment switching to LDT,ETV or combining LDT in ADV group patients with renal impairment.Conclusion:ADV is more likely lead to renal insufficiency than ETV in anti-hepatitis B virus treatment,and also is an independent predictor for renal dysfunction.Patients receiving ADV treatment should be monitored closely and regularly,especially patients with hypertension and/or diabetes,HBe Ag positive and potential renal damage.There is an obvious renal function improvement after patients with adefovir dipivoxil related renal damage switching to LDT,ETV or combining LDT,and no significant difference was observed among the three groups in this study.