Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Viral Hepat. 2021 Jan;28(1):51-60. doi: 10.1111/jvh.13401. Epub 2020 Oct 4.
Tenofovir disoproxil fumarate (TDF) effectively suppresses viral replication in chronic hepatitis B (CHB), but occasionally leads to renal impairment. We evaluated the prevalence of viral and biochemical breakthrough and renal function kinetics in renally impaired patients with CHB on reduced and on full-dose TDF. This clinic-based longitudinal cohort study included patients receiving full and reduced dose TDF (due to eGFR [Cockcroft-Gault] <60 mL/min/1.73 m ). Viral and biochemical breakthroughs were assessed 1 month after starting full and reduced TDF dose until the end-of-follow-up. Breakthroughs were studied in full and reduced dose TDF, and renal function (MDRD) longitudinally before and after dose reduction within patients starting on full-dose TDF. Of 750 patients on TDF, 78 (10%) had reduced dose and 672 (90%) full dose. At the time of dose reduction, 36 (46%) patients had chronic kidney disease stage G3B. A viral breakthrough occurred in one cirrhotic dialysis-dependent patient (dosed 300 mg weekly) which resolved without signs of decompensation, and in one patient on full dose which resolved spontaneously. One biochemical breakthrough occurred during dose reduction and resolved naturally without viral breakthrough. The MDRD improved within the first year of dose reduction (+3.0 [2.5] mL/min per year; P < .005) and remained stable thereafter. Fifty-three (79%) patients reached an MDRD >50 mL/min during dose reduction. Low dose TDF maintains renal function and viral suppression in most renally impaired patients with CHB, even in those with advanced liver disease. This useful, yet simple strategy could be particularly viable in resource-constrained settings.
富马酸替诺福韦二吡呋酯（TDF）可有效抑制慢性乙型肝炎（CHB）患者的病毒复制，但偶尔会导致肾功能损害。我们评估了接受减少剂量和全剂量 TDF 治疗的肾功能受损的 CHB 患者中病毒和生化突破以及肾功能动力学的发生率。这项基于诊所的纵向队列研究纳入了接受全剂量和减少剂量 TDF 治疗的患者（由于 eGFR [Cockcroft-Gault] <60 mL/min/1.73 m ）。在开始全剂量和减少剂量 TDF 后 1 个月评估病毒和生化突破，直至随访结束。在开始全剂量 TDF 的患者中，研究了全剂量和减少剂量 TDF 中的突破，并在剂量减少前后对肾功能（MDRD）进行了纵向研究。在接受 TDF 治疗的 750 例患者中，78 例（10%）接受了减少剂量治疗，672 例（90%）接受了全剂量治疗。在开始减少剂量时，36 例（46%）患者患有慢性肾脏病 G3B 期。1 例接受每周 300mg 剂量的肝硬化透析依赖患者发生了病毒突破，但无失代偿迹象，1 例全剂量患者自发解决。1 例生化突破发生在剂量减少期间，自然解决且无病毒突破。在剂量减少后的第一年，MDRD 改善（+3.0 [2.5] mL/min/年；P < 0.005），此后保持稳定。53 例（79%）患者在减少剂量期间达到 MDRD >50 mL/min。低剂量 TDF 可维持大多数肾功能受损的 CHB 患者的肾功能和病毒抑制，即使是那些患有晚期肝病的患者。这种有用且简单的策略在资源有限的环境中可能特别可行。
