entecavir and Renal-Insufficiency--Chronic

The treatment of chronic hepatitis B (CHB) in patients with chronic kidney disease (CKD) is based on nucleoside (lamivudine, telbivudine, entecavir) or nucleotide (adefovir, tenofovir) analogues (NAs), but it may be complex and the information is scarce. Entecavir and tenofovir represent the currently recommended first-line NAs for NA-naive CHB patients, while tenofovir is the NA of choice for CHB patients with resistance to nucleosides.. To review the efficacy and safety of NAs in adult CHB patients with CKD and to provide reasonable recommendations for their optimal management.. Literature search in PubMed/Medline and manual search of relevant articles, reviews and book chapters.. NAs are cleared by kidneys and their dosage should be adjusted in patients with creatinine clearance <50 mL/min. There are concerns about nephrotoxic potential of the nucleotides, particularly adefovir, while improvements of creatinine clearance have been reported under telbivudine. Most existing data in CHB patients with CKD are for lamivudine and, less frequently, for other NAs, mostly entecavir. Besides CHB, NA should be used in case of immunosuppressive therapy in any HBsAg-positive patient with CKD including renal transplant (RT) recipients and in anti-HBs-positive recipients of kidney grafts from HBsAg-positive donors.. Chronic hepatitis B patients with chronic kidney disease receiving nucleoside analogues should be followed carefully for treatment efficacy and renal safety. Despite the absence of strong data, entecavir and telbivudine seem to be the preferred options for nucleoside analogue-naive CHB patients with chronic kidney disease, depending on viraemia and severity of renal dysfunction. More studies are certainly needed in this setting.

Topics: Adenine; Antiviral Agents; Guanine; Hepatitis B, Chronic; Humans; Lamivudine; Nucleosides; Organophosphonates; Renal Insufficiency, Chronic; Telbivudine; Tenofovir; Thymidine

In clinical trials involving patients with preserved renal function, tenofovir disoproxil fumarate (TDF) use was associated with mild renal impairment in 1% of patients.. To compare serial renal function of entecavir (ETV)-treated, TDF-treated, and untreated patients with chronic hepatitis B.. We studied the risk of chronic kidney disease (CKD) progression in a territory-wide cohort of patients with chronic hepatitis B without treatment and of those on ETV or TDF treatment. Estimated glomerular filtration rate (eGFR) was determined by the CKD Epidemiology Collaboration equation and was classified into five CKD stages. CKD progression, defined as an increase of at least one CKD stage, was compared among treated and untreated patients.. After propensity score matching, 2254 ETV-treated, 2254 TDF-treated, and 2254 untreated patients were included in the analysis. Their mean baseline eGFR was 90.3 ± 19.6, 91.3 ± 20.6, and 92.2 ± 20.0 mL/min/1.73 m. The use of TDF was associated with mild renal impairment in a minority of patients; those treated with ETV had a similar risk compared to untreated patients.

Topics: Adult; Aged; Antiviral Agents; Cohort Studies; Disease Progression; Female; Glomerular Filtration Rate; Guanine; Hepatitis B, Chronic; Humans; Middle Aged; Registries; Renal Insufficiency, Chronic; Tenofovir; Treatment Outcome

Topics: Guanine; Hepatitis B; Hepatitis B, Chronic; Humans; Renal Insufficiency, Chronic; Tenofovir

Topics: Guanine; Hepatitis B, Chronic; Humans; Renal Insufficiency, Chronic; Tenofovir

This study aimed to evaluate the outcomes of chronic hepatitis B patients with cirrhosis who received long-term nucleos(t)ide analog therapy.. A total of 546 consecutive cirrhotic patients treated with entecavir (n = 359), telbivudine (n = 104), or tenofovir (n = 83) for chronic hepatitis B were enrolled. The incidence of hepatocellular carcinoma (HCC) and overall survival were evaluated.. Long-term nucleos(t)ide analog therapy does not guarantee against the HCC development and mortality in chronic hepatitis B-related cirrhotic patients. Careful HCC surveillance is necessary in patients with old age, statin use, low platelet count, and variceal bleeding history.

Topics: Adult; Aged; Antiviral Agents; Carcinoma, Hepatocellular; Female; Guanine; Hepatitis B, Chronic; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Proportional Hazards Models; Renal Insufficiency, Chronic; Telbivudine; Tenofovir; Thymidine; Treatment Outcome

Mixed cryoglobulinemia is occasionally seen in patients with hepatitis B virus (HBV) infection. This report presents the case of a quiescent HBV carrier who had type II mixed cryoglobulinemia, protracted purpura, ulcerative skin lesions and advanced chronic kidney disease. The cutaneous manifestations of the patient improved along with a decrease in the serum cryoglobulin and HBV-deoxyribonucleic acid levels following the initiation of oral entecavir in combination with plasmapheresis. However, the patient ultimately required prednisolone due to the limited benefits of these treatments. We also discuss various concerns regarding steroid treatment in patients with mixed cryoglobulinemia complicated by HBV infection.

Topics: Aged; Antiviral Agents; Combined Modality Therapy; Cryoglobulinemia; Cryoglobulins; DNA, Viral; Female; Guanine; Hepatitis B Antibodies; Hepatitis B Antigens; Hepatitis B, Chronic; Humans; Plasmapheresis; Prednisolone; Purpura; Renal Insufficiency, Chronic; Skin Ulcer