Patients with chronic hepatitis B (CHB) aged >60 years and patients who used diuretics and received treatment with tenofovir disoproxil fumarate (TDF) experienced a greater reduction in renal function compared with patients without those characteristics, according to study results study published in the Journal of Viral Hepatitis.

The study was performed to assess the real-world long-term effects of TDF on renal function. A cohort of 640 Korean patients with CHB who were treatment-naïve prior to receiving TDF between May 2010 and December 2015 was recruited. The mean age of the cohort was 48.3±12 years, and 59.5% were men. Percentage of hypertension and diabetes mellitus (DM) in the cohort was 11.6% and 14.2%, respectively, and 20.8% had liver cirrhosis.

Over the course of the 5-year follow-up, serum creatinine increased from 0.77±0.01 mg/dL to 0.85±0.02 mg/dL (P <.001), and estimated glomerular filtration rate (eGFR) decreased from 102.6±0.6 mL/min/1.73 m2 to 93.4±1.4 mL/min/1.73 m2 (P <.001). According to a subgroup analysis, eGFR was statistically more decreased in patients aged >60 years compared with patients aged <60 years (P =.027) and in patients who were compared with patients who were not receiving diuretics (P =.008).

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Independent risk factors for eGFR decrease >20% were found to be a baseline eGFR <60mL/min/1.73 m2 (hazard ratio [HR], 4.961; P =.007) and the use of diuretics (HR, 2.940; P <.001), as well as female sex (HR, 1.524, P =.038).

There was a possibility of selection bias in the study due to its retrospective cohort nature. Also, the study did not have a control group and only renal outcomes during TDF treatment were evaluated. Furthermore, the number of patients at 5 years after TDF treatment was relatively small due to late approval of TDF in Korea. This was, however, among the first Korean studies to evaluate 5-year renal outcomes in patients with CHB treated with TDF and it was performed in a real-world setting.

The investigators concluded that in Korean patients with CHB, renal function decreased moderately during the first 2 years of TDF treatment and was significantly decreased in patients aged >60 years and patients using diuretics. The study also identified 2 independent risk factors contribute to decreased eGFR >20%.

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Based on their findings, the investigators recommend that older patients, patients with decreased renal function, and patients taking diuretics should consider switching from TDF to other drugs such as tenofovir alafenamide fumarate.


Lim TS, Lee JS, Kim BK, et al. An observational study on long-term renal outcome in patients with chronic hepatitis B treated with tenofovir disoproxil fumarate [published online October 22 2019]. J Viral Hepat. doi:10.1111/jvh.13222