title: Similar risk of renal events among patients treated with tenofovir or entecavir for chronic hepatitis B.
abstract: OBJECTIVE
  Tenofovir is a nucleotide reverse-transcriptase inhibitor approved for treatment of human immunodeficiency virus infection, as well as chronic hepatitis B (CHB). We evaluated nephrotoxicity among patients with CHB treated with tenofovir.
  
  
  METHODS
  We performed a community-based, retrospective cohort study of 80 patients with CHB who received tenofovir, alone or in a combination regimen; they were matched for age and sex with 80 CHB patients who received only entecavir. Incidences of serum creatinine (SCr) increase ≥0.2 mg/dL and new SCr levels of 1.5, 2.0, or 2.5 mg/dL were assessed. Patients with an estimated glomerular filtration rate (eGFR) <60 mL/min, calculated using the Modification of Diet in Renal Disease or Cockcroft-Gault formula, or who had ≥20% decrease in eGFR were also recorded.
  
  
  RESULTS
  More patients given entecavir had increases in SCr ≥2.5 mg/dL (1 vs 6; P = .053), whereas more patients given tenofovir had a new Cockcroft-Gault eGFR of <60 mL/min (15 vs 6; P = .022) and at least 1 dose adjustment (13 vs 4; P = .021). By multivariate analysis, the only significant factors associated with an increase in SCr were a history of organ transplantation (adjusted odds ratio, 6.740; 95% confidence interval, 1.799-28.250; P = .005) and pre-existing renal insufficiency (adjusted odds ratio, 10.960; 95% confidence interval, 2.419-48.850; P = .002). No factors, including therapy assignment, were associated with a new eGFR <60 mL/min.
  
  
  CONCLUSIONS
  Markers of renal function indicated that patients who received tenofovir were no more likely to have changes in renal function than patients treated with entecavir. History of transplant and pre-existing renal insufficiency were the only factors independently associated with increases in SCr.
authors.affiliation: University of California at San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA. rgish@ucsd.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.forename: Margaret D
authors.initials: MD
authors.lastname: Clark
authors.forename: Steve D
authors.initials: SD
authors.lastname: Kane
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Michael F
authors.initials: MF
authors.lastname: Mangahas
authors.forename: Sumbella
authors.initials: S
authors.lastname: Baqai
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D000068698:Tenofovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D003404:Creatinine; D000225:Adenine