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Brayette A, Essig M, Carrier P, Debette-Gratien M, Labrunie A, Alain S, Maynard M, Ganne-Carrié N, Nguyen-Khac E, Pinet P, De Ledinghen V, Renou C, Mathurin P, Vanlemmens C, Di Martino V, Gervais A, Foucher J, Isabelle FH, Vergniol J, Hourmand-Ollivier I, Cohen D, Duval X, Poynard T, Bardou M, Abergel A, Dao MT, Thévenot T, Hiriart JB, Canva V, Lassailly G, Aurières C, Boyer N, Thabut D, Bernard PH, Schnee M, Larrey D, Hanslik B, Hommel S, Jacques J, Loustaud-Ratti V. Subclinical proximal tubulopathy in hepatitis B: The roles of nucleot(s)ide analogue treatment and the hepatitis B virus. World J Hepatol 2020; 12:1326-1340. [PMID: 33442458 PMCID: PMC7772739 DOI: 10.4254/wjh.v12.i12.1326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
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 tubulopathy. Multiple early markers are available, but no consensus exists on their use.
AIM 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 patients.
METHODS A prospective, non-randomized, multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was conducted. The patients were separated into three groups: Naïve, starting entecavir (ETV) treatment, or starting tenofovir disoproxil (TDF) treatment. Data on the early markers of SPT, the eGFR and phosphatemia, were collected quarterly. SPT 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 calculated. Quantitative data were analyzed using analyses of variance or Kruskal-Wallis tests, whereas chi-squared or Fisher’s exact tests were used to analyze qualitative data. Multivariate analyses were used to adjust for any potential confounding factors.
RESULTS Of the 196 patients analyzed, 138 (84 naïve, 28 starting ETV, and 26 starting TDF) had no SPT at inclusion. 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 m² or phosphatemia less than 0.48 mmoL/L. In the multivariate analysis, no explanatory variables were identified after adjustment. The 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 TDF groups, respectively. The median survival time without SPT, evaluated only in the TDF group, was 5.9 mo.
CONCLUSION The prevalence and incidence of SPT was higher in TDF-treated patients compared to naïve patients. SPT in the naïve population suggests that HBV can induce renal tubular toxicity.
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Affiliation(s)
- Anaïs Brayette
- U1248 INSERM, Department of Hepatology and Gastroenterology, Univ. Limoges, CHU Limoges, Limoges F-87000, France
| | - Marie Essig
- U1248 INSERM, Department of Nephrology and Transplantation, CHU Limoges, Limoges F-87000, France
| | - Paul Carrier
- U1248 INSERM, Department of Hepatology and Gastroenterology, Univ. Limoges, CHU Limoges, Limoges F-87000, France
| | - Marilyne Debette-Gratien
- U1248 INSERM, Department of Hepatology and Gastroenterology, Univ. Limoges, CHU Limoges, Limoges F-87000, France
| | - Anaïs Labrunie
- Department of Center of Epidemiology, Biostatistics and Research Methodology, CHU Limoges, Limoges F-87000, France
| | - Sophie Alain
- U1092 INSERM, Department of Virology, CHU Limoges, Limoges F-87000, France
| | - Marianne Maynard
- Department of Hepatology, Croix-Rousse University Hospital of Lyon, Lyon 69004, France
| | - Nathalie Ganne-Carrié
- Department of Hepatology, Jean Verdier University Hospital of Bondy, Bondy 93140, France
| | - Eric Nguyen-Khac
- Department of Hepato-Gastroenterology, Amiens University Hospital, Amiens 80054, France
| | - Pauline Pinet
- Department of Infectious Diseases, CHU Limoges, Limoges F-87000, France
| | - Victor De Ledinghen
- Department of Hepatology, Haut Leveque Hospital, Bordeaux University Hospital, Pessac 33604, France
| | - Christophe Renou
- Department of Gastroenterology, Hyeres Hospital, Hyeres 83407, France
| | - Philippe Mathurin
- Department of Hepato-Gastroenterology, Claude Huriez University Hospital, Lille 59037, France
| | - Claire Vanlemmens
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Vincent Di Martino
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Anne Gervais
- Department of Infectious Diseases, Bichat University Hospital, Paris 75018, France
| | - Juliette Foucher
- Department of Hepatology, Haut Leveque Hospital, Bordeaux University Hospital, Pessac 33604, France
| | | | - Julien Vergniol
- Department of Hepatology, Haut Leveque Hospital, Bordeaux University Hospital, Pessac 33604, France
| | | | - Daniel Cohen
- Department of General Medecine, University Hospital of Caen, Caen 14000, France
| | - Xavier Duval
- Department of Infectious Diseases, Bichat University Hospital, Paris 75018, France
| | - Thierry Poynard
- Department of Hepatology, La Pitié-Salpêtrière University Hospital, Paris 75651, France
| | - Marc Bardou
- Department of Hepatology and Gastroenterology, Dijon University Hospital, Dijon 21079, France
| | - Armand Abergel
- Department of Hepatology and Gastroenterology, Estaing University Hospital, Clermont Ferrand 63003, France
| | - Manh-Thong Dao
- Department of Hepato-Gastroenterology and Nutrition, University Hospital of Caen, Caen 14033, France
| | - Thierry Thévenot
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Jean-Baptiste Hiriart
- Department of Hepatology, Haut Leveque Hospital, Bordeaux University Hospital, Pessac 33604, France
| | - Valérie Canva
- Department of Hepato-Gastroenterology, Claude Huriez University Hospital, Lille 59037, France
| | - Guillaume Lassailly
- Department of Hepato-Gastroenterology, Claude Huriez University Hospital, Lille 59037, France
| | - Christine Aurières
- Department of Hepatology, Beaujon University Hospital, Clichy 92110, France
| | - Nathalie Boyer
- Department of Hepatology, Beaujon University Hospital, Clichy 92110, France
| | - Dominique Thabut
- Department of Hepatology, La Pitié-Salpêtrière University Hospital, Paris 75651, France
| | - Pierre-Henri Bernard
- Department of Hepatology, Saint-André University Hospital, Bordeaux 33000, France
| | - Matthieu Schnee
- Department of Hepatology and Gastroenterology, La Roche-Sur-Yon Hospital Center, La Roche-Sur-Yon 85000, France
| | - Dominique Larrey
- Department of Hepatology and Gastroenterology, University Hospital of Montpellier, Montpellier 34295, France
| | - Bertrand Hanslik
- Department of Addictology, Hospital of Montpellier, Montpellier 34295, France
| | - Séverine Hommel
- Department of Hepatology and Gastroenterology, Hospital Center of Aix en Provence, Aix-en-Provence 13100, France
| | - Jérémie Jacques
- U1248 INSERM, Department of Hepatology and Gastroenterology, Univ. Limoges, CHU Limoges, Limoges F-87000, France
| | - Véronique Loustaud-Ratti
- U1248 INSERM, Department of Hepatology and Gastroenterology, Univ. Limoges, CHU Limoges, Limoges F-87000, France
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