| Renal side effects of adefovir in hepatitis B virus-(HBV) positive kidney allograft recipients. | |
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MedLine Citation:
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PMID: 19203548 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: The purpose of this study was to evaluate the renal side-effects of adefovir therapy in kidney-transplant (KT) recipients with chronic hepatitis B virus (HBV) infection, who have become resistant to lamivudine therapy. PATIENTS AND METHODS: 11 kidney-transplant (KT) patients (10 men, 1 woman, median age 54 (46 - 67) years) had lamivudine-resistant chronic HBV infection. With respect to HBV markers, all were HBs Ag-positive, 8 were HBe Ag-negative/HBe antibody- (Ab) positive, i.e. precore mutant, and 3 were HBe Ag-positive/HBe Ab-negative. They were all given adefovir at 10 mg/d (3 cases) or 5 mg/d (6 cases) or 2.5 mg/d (2 cases) according to creatinine clearance. RESULTS: Compared to baseline without adefovir therapy, at last follow-up, adefovir therapy was associated, at 1 and 2 years post therapy, with a significant decrease in aspartate (AST) (28 (17 - 53), 28 (10 - 79) vs. 58 (24 - 1,282) IU/l, p = 0.001), alanine (ALT) (38 (13 - 55), 36 (17 - 92) vs. 72 (31 - 1,594) IU/l, p = 0.0032] aminotransferase levels, and gammaGT (31 (14 - 51), 25 (14 - 196) vs. 44 (25 - 742) IU/l, p = 0.03). With respect to HBV DNA, when compared to baseline, there was a significant decrease at both years 1 and 2 post therapy (p = 0.01). With respect to KT function at 2 years after starting adefovir, there was a significant increase in serum creatinine from 125 (+/- 35) to 141 (+/- 32) micromol/l, (p = 0.02) and a significant increase in 24-h proteinuria. With respect to renal tubular parameters, as compared to baseline without adefovir therapy, one year after adefovir therapy was commenced there was a significant decrease in urinary pH from 6.6 (+0.6) to 5.65 (+/- 0.7); p = 0.03, a significant decrease in bicarbonaturia (from 0.33 +/- 0.7 to 0.1 +/- 0.3 mmol/h, p = 0.01), an increase in urinary excretion of H+ (1.79 (+/- 1.33) to 2.44 (+/- 1.18) mmol/l (p = 0.03)), a significant decrease in phosphatemia (0.82 +/- 0.19 vs. 0.65 +/- 0.13 mmol/l, p = 0.04) and a significant decrease in phosphaturia threshold, a significant decrease in tubular phosphorus reabsorption (75.5 +/- 9.4% vs. 61.8 +/- 16%, p = 0.05), and a significant increase in the phosphorus index of excretion (0.18 +/- 0.114 vs. 0.35 +/- 0.164, p = 0.01). CONCLUSION: We have demonstrated that low-dosage adefovir therapy in kidney-transplant patients is relatively safe as far as renal parameters are concerned, even though we observed a slight impairment of renal proximal-tubular function. |
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Authors:
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N Kamar; A Huart; I Tack; L Alric; J Izopet; L Rostaing |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical nephrology Volume: 71 ISSN: 0301-0430 ISO Abbreviation: Clin. Nephrol. Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-02-10 Completed Date: 2009-03-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0364441 Medline TA: Clin Nephrol Country: Germany |
Other Details:
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Languages: eng Pagination: 36-42 Citation Subset: IM |
Affiliation:
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Nephrology, Dialysis and Multiorgan Transplant Unit, CHU Rangueil, Toulouse, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acid-Base Equilibrium
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drug effects Adenine / administration & dosage, adverse effects, analogs & derivatives* Aged Antiviral Agents / administration & dosage, adverse effects* Cohort Studies Dose-Response Relationship, Drug Drug Resistance, Viral Female Glomerular Filtration Rate / drug effects Hepatitis B, Chronic / drug therapy*, metabolism, physiopathology Humans Kidney / drug effects*, metabolism, physiopathology Kidney Transplantation* Lamivudine Male Middle Aged Phosphonic Acids / administration & dosage, adverse effects* Retrospective Studies |
| Chemical | |
Reg. No./Substance:
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0/Antiviral Agents; 0/Phosphonic Acids; 106941-25-7/adefovir; 134678-17-4/Lamivudine; 73-24-5/Adenine |
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