Improvement in renal function after switching from entecavir to tenofovir alafenamide in chronic hepatitis B patients with low estimated glomerular filtration rates

Both entecavir (ETV) and tenofovir alafenamide (TAF) are regarded as renal-friendly nucleoside/nucleotide analogs (NAs). However, the difference between ETV and TAF in terms of renal function remains unclear. This study aims to directly compare the renal safety profiles of two antiviral treatments, and evaluate the impact on renal function when switching from ETV to TAF treatment in chronic hepatitis B (CHB) patients with low estimated glomerular filtration rates(eGFR). The study enrolled 190 CHB patients who received ETV (n = 112) or TAF (n = 78) between the years 2019 and 2023. The effects of these NAs on renal function were assessed by measuring changes in eGFR levels from baseline to 72 weeks between the two treatment groups. Following a 1:1 propensity score matching procedure, each treatment group consisted of 76 patients. A significant disparity in the change of eGFR between the two cohorts was observed at week 36. Baseline eGFR and drug (ETV/TAF) were significant positive indicators for eGFR abnormality at week 36. In addition, 7 patients in the ETV group were switched to TAF due to eGFR abnormalities at week 48, and the eGFR changes from 48 to 72 weeks were significantly different between patients who remained on their initial treatment and those who switched from ETV to TAF. A significant difference in eGFR was observed between ETV and TAF treatments at week 36, and baseline eGFR and drug (ETV/TAF) were remarkable positive indicators for eGFR abnormality at week 36. Switching to TAF led to a substantial improvement in renal function among ETV-treated patients with eGFR abnormalities.