A cross-sectional study of renal dysfunction in chronic hepatitis B outpatients treated with nucleos(t)ide drugs in China
10.3760/cma.j.cn501113-20200526-00273
- VernacularTitle:一项中国慢性乙型肝炎门诊核苷（酸）类药物经治患者肾脏功能损害的横断面研究
- Author:
Jing LIU
1
;
Guangming XIAO
;
Fangfang LYU
;
Zhiliang GAO
Author Information
1. 中山大学附属第三医院感染科，广州 510630
- Keywords:
Chronic hepatitis B;
Nucleos(t)ide analogues treated;
Tubular impairment
- From:
Chinese Journal of Hepatology
2021;29(5):409-414
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the proportion of abnormal renal function indexes in outpatients with chronic hepatitis B (CHB), and to further explore the correlation between the history of nucleos(t)ide analogues (NA) antiviral therapy and abnormal renal function indexes.Methods:A cross-sectional design was adopted for renal function screening. Baseline characteristics, history of antiviral treatment, and renal function indexes were collected, including glomerular filtration rate (eGFR), blood urea nitrogen, blood creatinine, blood uric acid, and urine β2- microglobulin α 1-microglobulin and urinary protein. According to the definition and standard of abnormal renal function indexes, the correlation between chronic kidney disease (CKD) - 1/2 and related risk factors, renal tubular indicators and risk factors, and the correlation between antiviral treatment duration and renal tubular risk were analyzed. The data were analyzed by single and multi-factor regression.Results:2703 outpatients from 47 hospitals across the country were enrolled. 70.7% were males with an average age of 47.5 years. 15.5% of cases had hypertension, 14.6% cases had chronic kidney disease, 11.3% cases had diabetes, and 15.4% had CKD 1/2. Retinol-binding protein, urinary β2-microglobulin or urinary α1-microglobulin showed renal tubular damage rates of 10.4%, 27.1% and 18.4%, respectively. Renal tubular damage risk was related to the antiviral treatment duration ( OR = 1.06, 95% CI = 1.028 ~ 1.093). Multivariate analysis results showed that the risk factors related to eGFR < 90 ml/min in male were 40-60 or > 60 years old, high viral load, poorly controlled hypertension, use of nephrotoxic drugs, liver fibrosis status, family history of hepatitis B; while the risk factors related to eGFR < 60 ml/min in female were decompensated cirrhosis, poorly controlled diabetes, and family history of hepatitis B. Conclusion:CHB outpatients have a high proportion of chronic kidney damage, including early renal tubular damage, which suggests that baseline renal function should be assessed before NA use and closely monitored during the treatment. Regular monitoring of the renal tubular damage index can detect the risk of kidney damage earlier than the estimated eGFR.
