Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B.

Abstract

AIM:

To evaluate urine β2-microglobulin (β2-M), retinol-binding protein (RBP) excretion, and renal impairment with adefovir dipivoxil (ADV) for chronic hepatitis B.

METHODS:

We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy (n = 90) or ADV plus lamivudine combination therapy (n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate (eGFR) at the initiation of antiviral therapy and every 6 mo for a period of five years.

RESULTS:

Urine β2-M abnormalities were observed in patients during the first (n = 3), second (n = 7), third (n = 11), fourth (n = 16), and fifth (n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first (n = 2), second (n = 8), third (n = 12), fourth (n = 15), and fifth (n = 22) year of ADV treatment. eGFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in eGFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and eGFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment.

CONCLUSION:

Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.

• Authors: Hong-Yu Jia, Feng Ding, Jian-Yang Chen, Jiang-Shan Lian, Yi-Min Zhang, Lin-Yan Zeng, Dai-Rong Xiang, Liang Yu, Jian-Hua Hu, Guo-Dong Yu, Huan Cai, Ying-Feng Lu, Lin Zheng, Lan-Juan Li, Yi-Da Yang
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 21 Issue 12 Pg. 3657-62 (Mar 28 2015) ISSN: 2219-2840 [Electronic] United States
• PMID: 25834334 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Biomarkers
• Organophosphonates
• Retinol-Binding Proteins
• beta 2-Microglobulin
• entecavir
• Guanine
• Creatinine
• Adenine
• adefovir dipivoxil

Topics

• Acute Kidney Injury (chemically induced, diagnosis, physiopathology)
• Adenine (administration & dosage, adverse effects, analogs & derivatives)
• Adult
• Antiviral Agents (administration & dosage, adverse effects)
• Biomarkers (blood, urine)
• Case-Control Studies
• Creatinine (blood)
• Drug Substitution
• Female
• Glomerular Filtration Rate
• Guanine (administration & dosage, analogs & derivatives)
• Hepatitis B, Chronic (diagnosis, drug therapy)
• Humans
• Male
• Middle Aged
• Organophosphonates (administration & dosage, adverse effects)
• Predictive Value of Tests
• Prospective Studies
• Retinol-Binding Proteins (urine)
• Risk Factors
• Time Factors
• Treatment Outcome
• beta 2-Microglobulin (urine)