The treatment of chronic hepatitis B in patients with chronic kidney disease (CKD) is based on nucleoside (lamivudine, telbivudine, entecavir) or nucleotide (adefovir, tenofovir) analogues (NAs), but it may be complex and the information is scarce.
Entecavir and tenofovir represent the currently recommended first-line NAs for NA-naive chronic hepatitis B patients, while tenofovir is the NA of choice for chronic hepatitis B patients with resistance to nucleosides.
Dr Papatheodoridis and colleagues from Greece reviewed the efficacy and safety of NAs in adult chronic hepatitis B patients with chronic kidney disease and to provide reasonable recommendations for their optimal management.
The team performed a literature search in PubMed/Medline and manual search of relevant articles, reviews and book chapters.
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|Alimentary Pharmacology & Therapeutics|
NAs are cleared by kidneys and their dosage should be adjusted in patients with creatinine clearance <50 mL/min.
The team report concerns about nephrotoxic potential of the nucleotides, particularly adefovir, while improvements of creatinine clearance have been reported under telbivudine.
The researchers noted that most existing data in chronic hepatitis B patients with CKD are for lamivudine and, less frequently, for other NAs, mostly entecavir.
Besides chronic hepatitis B, NA should be used in case of immunosuppressive therapy in any HBsAg-positive patient with CKD including renal transplant (RT) recipients, and in anti-HBs-positive recipients of kidney grafts from HBsAg-positive donors.
Dr Papatheodoridis' team comments, "Chronic hepatitis B patients with chronic kidney disease receiving nucleoside analogues should be followed carefully for treatment efficacy and renal safety."
"Despite the absence of strong data, entecavir and telbivudine seem to be the preferred options for nucleoside analogue-naive chronic hepatitis B patients with chronic kidney disease, depending on viraemia and severity of renal dysfunction."
"More studies are certainly needed in this setting."