Introduction and objectives: Tenofovir alafenamide (TAF) and entecavir (ETV) are both considered renal-friendly nucleoside/nucleotide analogs (NAs). However, the difference between ETV and TAF in terms of renal function remains unclear. This study aims to compare the renal safety profiles of two antiviral medications directly and evaluate the impact of switching from ETV to TAF treatment on renal function in chronic hepatitis B (CHB) patients with low estimated glomerular filtration rates (eGFR).

Patients and methods: A total of 179 CHB patients who received TAF (n=84) or ETV (n = 95) between 2019 and 2023 were included in the study. Changes in eGFR levels between two treatment groups from baseline to 72 weeks were compared to measure the influence of these NAs on renal function.

Results: At baseline, 84 patients were included in each treatment group after a 1:1 propensity score matching process. At week 48, a notable different changes in eGFR were observed between the two groups. Gender, baseline eGFR, and medication (TAF/ETV) were significantly correlated with eGFR abnormalities. Furthermore, eGFR abnormalities at week 48 led to the transition of 6 patients in the ETV group to TAF. eGFR significantly increased (83.60 ± 5.45 vs. 93.39 ± 9.88 mL/min/1.73 m²; p=0.031) and serum creatinine significantly decreased (81.47±11.36 vs. 74.9±10.67 μmol/L; p=0.046) from week 48 to 60. At week 48, the incidence of low-level viremia (LLV) was 19.0% in the ETV group and 16.7% in the TAF group, respectively (p>0.05). Pairwise comparisons revealed no significant difference in the percentage of LLV between the ETV continued group and the TAF continued group at week 48, 60, and 72. Additionally, there was also no significant difference in the proportion of LLV between the ETV+TAF combination group and the TAF+ETV combination group at week 48, 60, and 72.

Conclusions: There was a substantial difference in eGFR between ETV and TAF treatments at week 48. Gender, baseline eGFR, and medication (TAF/ETV) were all remarkably positive indicators of eGFR abnormalities. In patients receiving ETV, an early switch to TAF may result in the reversal of early-stage renal damage.

Keywords: Entecavir; Hepatitis B virus; Renal function; Tenofovir alafenamide.

Copyright © 2025 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.

介绍与目标： Tenofovir艾拉酚胺（TAF）和恩替卡韦（ETV）都被认为是对肾脏友好的核苷/核苷酸类似物（NAs）。然而，关于ETV和TAF在肾功能方面的差异仍不清楚。本研究旨在直接比较两种抗病毒药物的肾脏安全性，并评估从ETV切换到TAF治疗对慢性乙型肝炎（CHB）患者低估计肾小球滤过率（eGFR）的影响。

患者与方法： 本研究共纳入了2019年至2023年间接受TAF（n=84）或ETV（n = 95）治疗的179名CHB患者。比较两组从基线到第72周eGFR水平的变化，以评估这些NAs对肾功能的影响。

结果： 在进行1:1倾向评分匹配过程后，每组分别有84名患者纳入了研究。在第48周时，两组之间eGFR变化显著不同。性别、基线eGFR和药物（TAF/ETV）与eGFR异常具有显着相关性。此外，在第48周发生eGFR异常后，6名ETV组患者转为接受TAF治疗。从第48周到第60周，eGFR显著增加（83.60 ± 5.45 vs. 93.39 ± 9.88 mL/min/1.73 m²; p=0.031），血清肌酐显著减少（81.47±11.36 vs. 74.9±10.67 μmol/L; p=0.046）。在第48周时，ETV组和TAF组的低水平病毒血症（LLV）发生率分别为19.0%和16.7%，无显著差异 (p>0.05)。成对比较显示，在第48、60和72周时，继续接受ETV治疗与持续使用TAF治疗组之间的LLV百分比没有显着差异。此外，在这些时间点上，ETV+TAF组合组与TAF+ETV组合组之间低水平病毒血症的比例也没有显著差异。

结论： 在第48周时，ETV和TAF治疗之间的eGFR存在显著差异。性别、基线eGFR以及药物（TAF/ETV）均为eGFR异常的明显积极指标。对于接受ETV治疗的患者，在早期转为使用TAF可能会逆转早期肾损伤。

关键词： 恩替卡韦；乙型肝炎病毒；肾功能；tenofovir艾拉酚胺

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