Sami KINIKLI, Ali Pekcan DEMİRÖZ, Fatih TEMOCİN, Meryem DEMİRELLİ, Çigdem HATİPOĞLU, Necla TÜLEK, Günay ERTEM, Cemal BULUT

Kronik Hepatit B Hastalarında Tenofovirin Böbrek Fonksiyonları Üzerine Etkisi

Amaç: Tenofovirle ilişkili olarak bildirilen en önemli yan etki nefrotoksisitedir. Çalışmamızda kronik hepatit B tanısı ile tenofovir tedavisi alan hastalarda, tenofovirin böbrek fonksiyonları üzerine olan etkisi kullanım süresine göre incelenmiştir.Yöntem ve Gereçler: Onsekiz yaşından küçük, birlikte hepatit C virus (HCV) ya da HIV ko-infeksiyonu olan, tedaviden önce böbrek yetmezliği olan ve ek başka bir ilaç kullanımı olan hastalar çalışma dışı bırakıldı. Hastaların üre ve kreatinin değerleri izlenmiş ve tahmini glomeruler filtrasyon hızı (eGFR), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) ve MDRD formülleri kullanılarak hesaplanmıştır. Kreatinin seviyeleri AKIN (Acute Kidney Injury Network) sınıflaması temel alınarak değerlendirilmiş ve tedavi süresince kreatin seviyelerinde 0,3 mg/dl'den fazla artış evre 1 yetmezlik olarak tanımlanmıştır. Bulgular: Çalışmaya tenofovir tedavisi başlanmış olan ve halen kullanan 104 KHB hastası alındı. Takip sırasında 2 hastada kreatin değerlerindeki değişim AKIN sınıflaması evre 1'e uymaktaydı. Bu iki hasta da dâhil hiçbir hastamızda eGFR değeri 50 mL/dk altına düşmemiştir. Tüm hastalar değerlendirildiğinde ortalama kreatinin değerlerinde zaman içinde bir artış görülmekle birlikte bu artış istatistiksel olarak anlamlı değildi (p=0,944). Her iki yöntemle bakılan eGFR değerlerinde yıllar içinde anlamlı bir değişim görülmemiştir. Hiçbir hastada doz azaltılmasına veya ilacın kesilmesine gerek duyulmamıştır. Sonuç: Sonuç olarak; tenofovire bağlı nefrotoksisite gelişimi KHB hastalarının tedavisinde en azından ilk yıllarda sık karşılaşılan bir sorun değildir. Bununla birlikte tenofovirin uzun süreli kullanım ile ilgili henüz yeterli veri oluşmadığından hastaların izlenmesi gerekmektedir

Effect of tenofovir on renal functions in patients with chronic hepatitis B

Aim: Nephrotoxicity is declared as the major side effect of tenofovir. In the present study, the effect of tenofovir on renal functions was evaluated in patients with chronic hepatitis B receiving tenofovir therapy, we tried to obtain a real lifedata.Materials and methods: Urea and creatinine values of patients were examined and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology) and MDRD (Modification of Diet in Renal Diseases) formulae. Creatinine levels were evaluated according to the AKIN (Acute Kidney Injury Network) classification and more than 0.3 mg/dl increase in on-treatment creatinine levels were defined as stage 1 failure.Results: A hundred and four patients already receiving tenofovir therapy were included in the study. None of the patients had eGFR less than 50 mL/minutes. When the results of all patients were analyzed, an increase in the mean creatinine levels by years was observed which was statistically non-significant (p=0.944). None of the patients required dose reduction or discontinuation of drug therapy.Conclusion: In conclusion, we might say that development of tenofovir-related nephrotoxicity is not a common occurrence in CHB patients at least during the first years of therapy. However, there is not sufficient data associated with long term tenofovir use since monitoring of patients is required

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