| Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chronic hepatitis B. | |
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MedLine Citation:
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PMID: 22506503 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Adefovir and tenofovir are nucleotide analogues used as long-term therapy of chronic hepatitis B. Side effects are few, but prolonged and high-dose therapy has been associated with proximal renal tubular dysfunction (RTD). AIM: To assess the incidence of RTD during long-term nucleotide therapy of chronic hepatitis B. METHODS: A total of 51 patients being treated at the Clinical Center, National Institutes of Health were studied. Diagnosis of RTD required de novo appearance of at least three of five features: hypophosphataemia, hypouricaemia, serum creatinine elevation, proteinuria or glucosuria. RESULTS: Among 51 patients treated for 1-10 (mean 7.4) years with adefovir (n = 42), tenofovir (n = 4) or adefovir followed by tenofovir (n = 5), 7 (14%) developed RTD. Time to onset ranged from 22 to 94 (mean 49) months with an estimated 10-year cumulative rate of 15%. All seven had low urinary percent maximal tubular reabsorption of phosphate (<82%). Patients with RTD were older (58 vs. 44 years; P = 0.01) and had lower baseline glomerular filtration rates (82 vs. 97 cc/min; P = 0.08) compared to those without; but did not differ in other features. Six patients with RTD were switched to entecavir, all subsequently had improvements in serum phosphate (2.0-3.0 mg/dL), creatinine (1.6-1.1 mg/dL), uric acid (2.7-3.8 mg/dL) and proteinuria. CONCLUSIONS: Renal tubular dysfunction develops in 15% of patients treated with adefovir or tenofovir for 2-9 years and is partially reversible with change to other antivirals. Monitoring for serum phosphate, creatinine and urinalysis is prudent during long-term adefovir and tenofovir therapy. |
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Authors:
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N Gara; X Zhao; M T Collins; W H Chong; D E Kleiner; T Jake Liang; M G Ghany; J H Hoofnagle |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Intramural Date: 2012-04-16 |
Journal Detail:
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Title: Alimentary pharmacology & therapeutics Volume: 35 ISSN: 1365-2036 ISO Abbreviation: Aliment. Pharmacol. Ther. Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-05-02 Completed Date: 2012-08-16 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 8707234 Medline TA: Aliment Pharmacol Ther Country: England |
Other Details:
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Languages: eng Pagination: 1317-25 Citation Subset: IM |
Copyright Information:
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Published 2012. This article is a US Government work and is in the public domain in the USA. |
Affiliation:
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Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA. naveen.gara@nih.gov |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenine
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adverse effects,
analogs & derivatives* Adult Aged Antiviral Agents / adverse effects* Biological Markers / metabolism Creatinine / metabolism Female Glomerular Filtration Rate / drug effects* Hepatitis B, Chronic / drug therapy* Humans Kidney Tubules / drug effects Male Middle Aged Organophosphonates / adverse effects* Phosphates / metabolism Renal Insufficiency / chemically induced* Time Factors Uric Acid / metabolism |
| Grant Support | |
ID/Acronym/Agency:
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ZIA DE000649-17/DE/NIDCR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antiviral Agents; 0/Biological Markers; 0/Organophosphonates; 0/Phosphates; 106941-25-7/adefovir; 107021-12-5/tenofovir; 60-27-5/Creatinine; 69-93-2/Uric Acid; 73-24-5/Adenine |
| Comments/Corrections | |
Comment In:
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Aliment Pharmacol Ther. 2012 Nov;36(10):992-3; author reply 993
[PMID:
23072605
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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