Nationwide analysis of renal outcomes in chronic hepatitis B patients treated with Tenofovir Alafenamide vs. Entecavir

초록

Patients with chronic hepatitis B (CHB) are at a higher risk of chronic kidney disease (CKD) compared to the general population. This study compared renal outcomes in treatment-naive CHB patients receiving tenofovir alafenamide (TAF) or entecavir (ETV) using South Korea's nationwide health insurance database. Two cohorts were analyzed: patients with normal renal function (cohort 1) and those with CKD but not end-stage renal disease (ESRD) (cohort 2). Propensity score matching (PSM) balanced baseline characteristics. Before PSM, ETV users had higher CKD (10.88 vs. 4.48 per 1000 person-years, incidence rate ratio [IRR] 2.43, 95% CI 2.13-2.77) and ESRD rates (40.33 vs. 22.13, IRR 1.82, 95% CI 1.26-2.63) than TAF users. Post-PSM, CKD and ESRD incidence showed no significant difference (CKD IRR 1.20, 95% CI 0.69-2.10; ESRD IRR 1.49, 95% CI 0.81-2.75). Cox regression confirmed that the antiviral agent was not a significant predictor of CKD or ESRD. In conclusion, TAF and ETV demonstrated similar renal safety profiles in CHB patients. These findings provide robust evidence for clinical decision-making, particularly for patients at risk of renal impairment.

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