Longitudinal changes in renal function in patients with chronic hepatitis B on antiviral treatment

Summary Background Patients with chronic hepatitis B (CHB) on nucleos(t)ide analogues (NUCs) often experience renal function decline. Conflicting results regarding the impact of NUC use and renal function have recently been reported. Aim To examine longitudinal changes in renal function according to the NUC treatment type compared with untreated patients Methods From 2014 to 2022, we retrospectively analysed 10,642 patients with CHB. The primary outcome was chronic kidney disease (CKD) progression, which was defined as a minimum one‐stage elevation. We applied propensity score (PS) matching for outcome comparisons. Results In the PS‐matched cohort of 1996 pairs, the NUC‐treated group (7.6/100 person‐years [PYs]) had a significantly higher CKD progression risk than the untreated group (4.4/100 PYs), with a hazard ratio (HR) of 1.70 ( p < 0.001). The tenofovir disoproxil fumarate (TDF)‐treated group (7.9/100 PYs) showed a 1.76‐fold increased CKD progression risk compared with the untreated group (4.5/100 PYs) in the PS‐matched cohort ( p < 0.001). Both the entecavir‐ and tenofovir alafenamide (TAF)‐treated groups showed CKD progression risks comparable to those of the untreated group in the PS‐matched cohorts of 755 and 426 pairs, respectively ( p = 0.132 and p = 0.120, respectively). No significant CKD progression risk was found between the entecavir‐ (6.0/100 PYs) and TAF‐treated (5.2/100 PYs) groups in the PS‐matched cohort of 510 pairs ( p = 0.118). Conclusions NUC‐treated patients, especially those on TDF, faced a higher CKD progression risk than untreated patients. Entecavir‐ and TAF‐treated patients had comparable CKD progression risks to untreated patients. No difference was observed between entecavir and TAF in the risk of CKD progression.