Efficacy and safety of Entecavir for Hepatitis B virus-associated Glomerulonephritis with renal function insufficient

Abstract Background HBV-GN is one of the most common secondary kidney diseases in China. Entecavir is one of the first-line antiviral nucleoside drugs at present, which can also effectively apply to antiviral therapy for HBV-GN.Objective The retrospective study to explore whether the entecavir is efficacy and safety for the treatment of Hepatitis B virus-associated glomerulonephritis(HBV-GN) with renal function insufficient.Methods We screened patients diagnosed with HBV-GN in The Affiliated Hospital of Qingdao University, elevated serum creatinine at 130umol/l ~ 250umol/l. Group 1 (30 patients) was given entecavir as antiviral treatment. Group 2 (28 patients) was treated with angiotensin II receptor blocker (ARB). The changes of renal function and the possible influencing factors were observed, with a mean follow-up time of 36 months.Results Baseline demographic and clinical parameters were not different between the 2 groups. For both cohorts, serum creatinine levels were increased gradually and the levels of eGFR declined progressively during the follow-up. At the end of the follow-up, serum creatinine levels in group 1 (t = 1.64, P = 0.1) and in group 2 ( t = 4.35, P = 0.001) were considered statistically significant compared to baseline creatinine. The levels of eGFR in group 1 (t = 2.37, P = 0.0018) and in group 2 ( t = 4.35, P = 0.001) were considered statistically significant compared to baseline eGFR. Comparison between the two groups showed that the elevated serum creatinine level and reduction in the level of eGFR were significantly lower in group 1 (t = 2.67, P = 0.008) than in group 2 (t = 2.76, P = 0.006), which were considered statistically significant. At the same time, cumulative renal survival, using end-stage renal disease (ESRD, eGFR < 15ml/min) as the primary renal endpoint, was 96.7% in group 1 and 67.9% in group 2 respectively (P = 0.005). Meanwhile, urine protein excretion was significantly decreased in both groups compared with baseline values, group 1 (t = 5.74, P = 0.001) and group 2 (t = 4.27, P = 0.001), while no significant difference was found(P = 0.370)in both groups. We performed a multivariate Cox regression analysis required eGFR < 15ml/min as the primary end point, then we found that the entecavir treatment and remission of proteinuria were the protective factors of renal function impairment, while the lower baseline eGFR was the risk factor of the progression of ESRD.Conclusion Entecavir treatment slows the progression of renal function impairment in HBV-GN, meanwhile, entecavir shows a significantly renal protective effect.