Longitudinal renal changes in chronic hepatitis B patients treated with entecavir versus TDF: a REAL-B study

Lung Yi Mak, Joseph Hoang, Dae Won Jun, Chien Hung Chen, Cheng Yuan Peng, Ming Lun Yeh, Sung Eun Kim, Daniel Q. Huang, Jae Yoon Jeong, Eileen Yoon, Hyunwoo Oh, Pei Chien Tsai, Chung Feng Huang, Sang Bong Ahn, Huy Trinh, Qing Xie, Grace L.H. Wong, Masaru Enomoto, Jae Jun Shim, Dong Hyun LeeLi Liu, Ritsuzo Kozuka, Yong Kyun Cho, Soung Won Jeong, Hyoung Su Kim, Lindsey Trinh, Allen Dao, Rui Huang, Rex Wan Hin Hui, Vivien Tsui, Sabrina Quek, Htet Htet toe Wai Khine, Eiichi Ogawa, Chia Yen Dai, Jee Fu Huang, Ramsey Cheung, Chao Wu, Wan Long Chuang, Seng Gee Lim, Ming Lung Yu, Man Fung Yuen, Mindie H. Nguyen

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background and aims: We aimed to compare the longitudinal changes in estimated glomerular filtration rate (eGFR) in chronic hepatitis B (CHB) patients treated with entecavir (ETV) vs. tenofovir disoproxil fumarate (TDF). Methods: This is a retrospective study of 6189 adult treatment-naïve CHB patients initiated therapy with TDF (n = 2482) or ETV (n = 3707) at 25 international centers using multivariable generalized linear modeling (GLM) to determine mean eGFR (mL/min/1.73 m2) and Kaplan–Meier method to estimate incidence of renal impairment (≥ 1 chronic kidney disease [CKD] stage worsening). We also examined above renal changes in matched ETV and TDF patients (via propensity score matching [PSM] on age, sex, diabetes mellitus [DM], hypertension [HTN], cirrhosis, baseline eGFR, and follow-up duration). Results: In the overall cohort (mean age 49.7 years, 66.2% male), the baseline eGFR was higher for TDF vs. ETV group (75.9 vs. 74.0, p = 0.009). PSM yielded 1871 pairs of ETV or TDF patients with baseline eGFR ≥ 60 and 520 pairs for the eGFR < 60 group. GLM analysis of the overall (unmatched) cohort and PSM cohorts revealed lower adjusted mean eGFRs in TDF (vs. ETV) patients (all p < 0.01) during 10 years of follow-up. Among PSM eGFR ≥ 60 patients, the 5-year cumulative incidences of renal impairment were 42.64% for ETV and 48.03% for TDF (p = 0.0023). In multivariable Cox regression, TDF vs. ETV (adjusted HR 1.26, 95% CI 1.11–1.43) was associated with higher risk of worsening renal function. Conclusion: Over the 10-year study follow-up, compared to ETV, TDF was associated with a lower mean eGFR and higher incidence of renal impairment.

Original languageEnglish
Pages (from-to)48-58
Number of pages11
JournalHepatology International
Issue number1
Publication statusPublished - Feb 2022

All Science Journal Classification (ASJC) codes

  • Hepatology


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