Tenofovir Alafenamide versus Entecavir in the Treatment of Renal Safety in Patients with Chronic Hepatitis B: An Observational Study

Background and aims: Urinary α ₁ -microglobulin (α ₁ -MG), β ₂ -microglobulin (β ₂ -MG), urinary N-acetyl-β-glucosaminidase (NAG) and retinol-binding protein (RBP) have predictive effects on renal tubular injury, the purpose of this study is to investigate whether the renal tubular abnormalities in chronic hepatitis B (CHB) patients during long-term entecavir (ETV) treatment cloud be improved after altering to tenofovir alafenamide(TAF). Methods：This study included 224 CHB patients of abnormal renal tubular markers from June 2022 to September 2023, of which 122 patients continuing ETV and 102 patients of altering to TAF for 6 months. Propensity score matching was used to analyze the differences of renal tubular indexes between the continuing ETV treatment and altering to TAF treatment. Results: A 1:1 propensity score match yielded 62 patients in each treatment group.The baseline characteristics, the ratio of complete virology respond,liver blood phosphorus, the estimated glomerular filtration rate (eGFR), α ₁ -MG, β ₂ -MG, NAG, RBP were comparable between the two groups. After 6 months, the level of eGFR(ETV:101.5mL/(min*1.73m ² ),TAF:100.1mL/(min*1.73m ² ),p>0.05),RBP(△ETV -0.159 △TAF -0.213,p>0.05), the ratio of complete virology response(ETV 87.1% TAF 91.9%,P< 0.05) were statistically different.The difference ratio of α ₁ -MG, β ₂ -MG, NAG, blood phosphorus was statistically significant（p<0.05）。TAF decreased more than ETV in α1-MG, β2-MG, NAG indicators(△ETV: -4.016, -0.373,-0.852, △TAF: -12.050, -1.272, -5.583），TAF increased less than ETV in blood phosphorus (△ETV +0.019, △TAF -0.286）。 Conclusion: Altering to TAF of CHB patients with renal tubular abnormalities after long-term use of ETV , the treatment efficacy and renal tubular damage can be improved, indicating that TAF has better renal safety than ETV.