Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6306-6314
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6306
Early renal injury indicators can help evaluate renal injury in patients with chronic hepatitis B with long-term nucleos(t)ide therapy
Tong-Tong Ji, Ning Tan, Hai-Ying Lu, Xiao-Yuan Xu, Yan-Yan Yu
Tong-Tong Ji, Ning Tan, Hai-Ying Lu, Xiao-Yuan Xu, Yan-Yan Yu, Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
Author contributions: Ji TT acquired the data and wrote the manuscript; Tan N analyzed the data and wrote the manuscript; Lu HY designed the research and reviewed and approved the final manuscript; Xu XY and Yu YY instructed the research.
Supported by the National 12th Five-Year Plan for Science and Technology, No. 2018ZX10725-506.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking University First Hospital in 2018 (Research No. 264).
Informed consent statement: Patients who were enrolled in the work provided written informed consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Ying Lu, PhD, Associate Professor, Department of Infectious Diseases, Peking University First Hospital, No. 8 Xishiku Road, Xicheng District, Beijing 100034, China. luhaiying00@126.com
Received: September 23, 2020
Peer-review started: September 23, 2020
First decision: September 29, 2020
Revised: October 6, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 26, 2020
Abstract
BACKGROUND

Patients with chronic hepatitis B (CHB) with long-term nucleos(t)ide therapy may experience renal insufficiency. Traditional renal function indicators, such as urine protein, serum urea nitrogen (BUN), and serum creatinine, are normal when early mild lesions occur. Therefore, more sensitive renal function indicators are needed.

AIM

To investigate the significance of early renal injury indicators in evaluating renal injury in patients with CHB with long-term nucleos(t)ide therapy.

METHODS

We collected the clinical data of 69 outpatients with CHB at Peking University First Hospital from March 2018 to January 2020 who had been treated with long-term nucleos(t)ide therapy and analyzed the results of early renal injury indicators. Continuous normal distribution data were analyzed by the t-test to determine the difference between two groups. Continuous non-normally distributed data were analyzed by the Mann-Whitney U-test between two groups. The Kruskal-Wallis H test was used to determine the differences among multiple groups. Enumeration data were analyzed by the chi-square test. The related factors of early renal injury indicators were analyzed by logistic regression analysis.

RESULTS

The average treatment duration with nucleos(t)ide analogs of the 69 patients with CHB was 99.7 ± 28.7 mo. The cases of patients with elevated BUN and hypophosphatemia were 6 (8.7%) and 13 (18.8%), respectively; 31 (44.9%) patients had abnormal early renal injury indicators, including 9 patients with abnormal urine microalbumin, 7 patients with abnormal urine immunoglobulin, 6 patients with abnormal urine transferrin, and 19 patients with abnormal α1 microglobulin. There were no significant differences in the mean values of age, sex, BUN, estimated glomerular filtration rate (eGFR), serum uric acid, serum calcium, or serum phosphorus between the two groups of patients with and without early renal injury indicators. However, the mean levels of serum creatinine and urine creatinine, N-acetyl-β-D-glucosidase enzyme, α1 microglobulin, and urine immunoglobulin in the former group of patients were significantly higher than those in the latter group of patients (P < 0.05). The incidence of early renal injury in patients with eGFR ≥ 90, 60-89, and 30-59 mL/(min·1.73 m2) was 36.4% (8/22), 47.6% (20/42), and 60% (3/5), respectively. Logistic regression analysis results showed that gamma-glutamyl transpeptidase [odds ratio (OR) = 1.05 (1.008-1.093), P = 0.020], direct bilirubin [OR = 1.548 (1.111-2.159), P = 0.010], serum creatinine [OR = 1.079 (1.022-1.139), P = 0.006], and age [OR = 0.981 (0.942-1.022), P = 0.357] were independent predictors of early renal injury.

CONCLUSION

Patients with CHB treated with long-term nucleos(t)ide analog therapy had a high probability of early renal injury, and early renal injury indicators were highly sensitive and could be used to monitor early renal impairment.

Keywords: Early renal injury, Chronic hepatitis B, Nucleos(t)ide analog, N-acetyl-β-D-glucosidase enzyme, α1 microglobulin, Urine immunoglobulin

Core Tip: Early renal injury indicators had higher sensitivity and could be used to screen early renal injury in patients with chronic hepatitis B with long-term nucleos(t)ide analog therapy.