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Subclinical proximal tubulopathy in hepatitis B:The roles of nucleot(s)ide analogue treatment and the hepatitis B virus

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World Journal of Hepatology 2020年第12期12卷 1326-1340页

作者： Anais Brayette Marie Essig Paul Carrier Marilyne Debette-Gratien Anais Labrunie Sophie Alain Marianne Maynard Nathalie Ganne-Carrie Eric Nguyen-Khac Pauline Pinet Victor De Ledinghen Christophe Renou Philippe Mathurin Claire Vanlemmens Vincent Di Martino Anne Gervais juliette foucher Fouchard-Hubert Isabelle Julien Vergniol Isabelle Hourmand-Ollivier Daniel Cohen Xavier Duval Thierry Poynard Marc Bardou Armand Abergel Manh-Thong Dao Thierry Thevenot Jean-Baptiste Hiriart Valerie Canva Guillaume Lassailly Christine Aurières Nathalie Boyer Dominique Thabut Pierre-Henri Bernard Matthieu Schnee Dominique Larrey Bertrand Hanslik Severine Hommel Jeremie Jacques Veronique Loustaud-Ratti U1248 INSERM Department of Hepatology and GastroenterologyUniv.LimogesCHU LimogesLimoges F-87000France U1248 INSERM Department of Nephrology and TransplantationCHU LimogesLimoges F-87000France Department of Center of Epidemiology Biostatistics and Research MethodologyCHU LimogesLimoges F-87000France U1092 INSERM Department of VirologyCHU LimogesLimoges F-87000France Department of Hepatology Croix-Rousse University Hospital of LyonLyon 69004France Department of Hepatology Jean Verdier University Hospital of BondyBondy 93140France Department of Hepato-Gastroenterology Amiens University HospitalAmiens 80054France Department of Infectious Diseases CHU LimogesLimoges F-87000France Department of Hepatology Haut Leveque HospitalBordeaux University HospitalPessac 33604France Department of Gastroenterology Hyeres HospitalHyeres 83407France Department of Hepato-Gastroenterology Claude Huriez University HospitalLille 59037France Department of Hepatology Jean Minjoz University HospitalBesançon 25030France Department of Infectious Diseases Bichat University HospitalParis 75018France Department of Hepatology University Hospital of AngersAngers 49933France Department of Hepato-Gastroenterology and Nutrition University Hospital of CaenCaen 14033France Department of General Medecine University Hospital of CaenCaen 14000France Department of Hepatology La Pitié-Salpêtrière University HospitalParis 75651France Department of Hepatology and Gastroenterology Dijon University HospitalDijon 21079France Department of Hepatology and Gastroenterology Estaing University HospitalClermont Ferrand 63003France Department of Hepatology Beaujon University HospitalClichy 92110France Department of Hepatology Saint-AndréUniversity HospitalBordeaux 33000France Department of Hepatology and Gastroenterology La Roche-Sur-Yon Hospital CenterLa Roche-Sur-Yon 85000France Department of Hepatology and Gastroenterology University Hospital of MontpellierMontpellier 34295France Department of Addictology Hospita

BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity,such as estimated glomerular filtration rate(eGFR)and phosphatemia,are late markers of proximal *** early markers are available,but no consensus exists on their *** To determine the 24 mo prevalence of subclinical proximal tubulopathy(SPT),as defined with early biomarkers,in treated vs untreated hepatitis B virus(HBV)-monoinfected *** A prospective,non-randomized,multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was *** patients were separated into three groups:Naïve,starting entecavir(ETV)treatment,or starting tenofovir disoproxil(TDF)*** on the early markers of SPT,the eGFR and phosphatemia,were collected *** was defined as a maximal tubular reabsorption of phosphate/eGFR below 0.8 mmoL/L and/or uric acid fractional excretion above 10%.The prevalence and cumulative incidence of SPT at month 24(M24)were *** data were analyzed using analyses of variance or Kruskal-Wallis tests,whereas chi-squared or Fisher’s exact tests were used to analyze qualitative *** analyses were used to adjust for any potential confounding *** Of the 196 patients analyzed,138(84 naïve,28 starting ETV,and 26 starting TDF)had no SPT at *** M24,the prevalence of SPT was not statistically different between naïve and either treated group(21.1%vs 30.7%,P<0.42 and 50.0%vs 30.7%,P=0.32 for ETV and TDF,respectively);no patient had an eGFR lower than 50 mL/min/1.73 m²or phosphatemia less than 0.48 mmoL/*** the multivariate analysis,no explanatory variables were identified after *** cumulative incidence of SPT over 24 mo(25.5%,13.3%,and 52.9%in the naïve,ETV,and TDF groups,respectively)tended to be higher in the TDF group vs the naïve group(hazard ratio:2.283,P=0.05).SPT-free survival at M24 was 57.6%,68.8%,and 23.5%for the naïve,ETV,and TD

关键词： Hepatitis B virus Proximal tubulopathy Biomarkers Renal insufficiency Nucleoside analogues

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