中山醫學大學機構典藏 CSMUIR:Item 310902500/23737
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    题名: Evaluating the renal safety of tenofovir disoproxil fumarate in hepatitis B patients without chronic kidney disease
    作者: Tsai, HJ;Chuang, YW;Yang, SS;Chang, YZ;Chang, HR;Lee, TY
    关键词: ageing;entecavir;hepatitis B virus;renal dysfunction;tenofovir
    日期: 2021
    上传时间: 2022-08-05T09:42:04Z (UTC)
    出版者: WILEY
    ISSN: 1352-0504
    摘要: The nephrotoxicity of tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB) patients without chronic kidney disease (CKD) remains controversial. We aimed to evaluate nephrotoxicity of TDF in this population. In this hospital-based cohort study, CHB patients who received either TDF or entecavir (ETV) therapy, and did not have underlying CKD, were retrospectively recruited from January, 2008 to January, 2019. After excluding those with confounding conditions, 257 TDF-treated patients were matched through propensity scores with 514 ETV-treated patients. Cumulative incidences of, and hazard ratios (HRs) for the CKD guideline-defined renal dysfunction, were analysed. The mean decline in glomerular filtration rate was similar over 60 months (TDF vs. ETV: 10.1 ml/min/1.73 m(2), 95% confidence interval [CI]: 7.4-12.7 vs. 8.0 ml/min/1.73 m(2), 95% CI: 6.4-9.6; p = .34). The 5-year cumulative incidence of renal dysfunction was not significantly different (TDF vs. ETV: 10.4%, 95% CI: 5.6-18.0 vs. 5.8%, 95% CI: 3.6-9.0; p = .18). However, in multivariable stratified analysis, TDF was associated with an increased risk of renal dysfunction in the elderly (age >= 60 years), when compared to ETV (HR 2.86, 95% CI: 1.02-8.01; p < .05). For confirming the effect of TDF amongst the elderly, 61 TDF-treated patients were further matched with 183 ETV-treated patients, with 5-year cumulative incidence of renal dysfunction being significantly higher in TDF users (TDF vs. ETV: 34.4%, 95% CI: 17.7-59.8 vs. 15.5%, 95% CI: 9.4-25.1; p < .05). TDF use was independently related to renal dysfunction (HR 2.71, 95% CI: 1.19-6.14; p < .05). Although TDF is generally safe for CHB patients without CKD, it is best to be avoided in the elderly.
    URI: http://dx.doi.org/10.1111/jvh.13603
    https://www.webofscience.com/wos/woscc/full-record/WOS:000694982700001
    https://ir.csmu.edu.tw:8080/handle/310902500/23737
    關聯: JOURNAL OF VIRAL HEPATITIS ,2021,v28,issue 11, P1579-1586
    显示于类别:[中山醫學大學研究成果] 期刊論文

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