Bone and renal safety of initial antiviral therapy using tenofovir alafenamide fumarate or entecavir for chronic hepatitis B

doi:10.3748/wjg.v32.i22.117500

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jun 14, 2026; 32(22): 117500
Published online Jun 14, 2026. doi: 10.3748/wjg.v32.i22.117500

Table 1 Baseline condition description of 95 patients, n (%)/mean ± SD/median (Q1, Q3)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	t/χ² value	P value
Age, years	40.20 ± 11.08	41.74 ± 12.24	41.01 ± 11.67	0.640	0.524
Sex (male/female)	29/16	26/24	55/40	1.505	0.220
Compensated cirrhosis	10 (22.2)	8 (16.0)	18 (18.9)	0.597	0.440
Comorbidity rate	7 (15.6)	6 (12.0)	13 (13.7)	0.253	0.615
ALT	34.90 (19.40, 44.9)	30.80 (23.53, 39.25)	32.00 (21.7, 42.2)	0.160	0.873
HBV-DNA viral load (lg₁₀)	4.47 ± 2.16	4.28 ± 1.84	4.38 ± 1.99	0.365	0.717
Serum calcium	2.33 ± 0.13	2.30 ± 0.15	2.32 ± 0.14	0.935	0.352
Serum phosphorus	1.12 ± 0.21	1.12 ± 0.19	1.11 ± 0.19	0.026	0.980
Serum 25-hydroxyvitamin D₃	22.67 ± 7.98	24.96 ± 11.30	23.88 ± 9.90	1.122	0.265
Blood urea	5.08 (4.31, 5.64)	4.46 (3.65, 5.05)	4.61 (3.81, 5.44)	2.602	0.011
Serum creatinine	62.00 (53.00, 69.00)	58.00 (50.00, 63.00)	59.00 (50.00, 65.00)	1.314	0.192
Serum retinol-binding protein	38.70 (32.20, 45.60)	28.85 (26.18, 31.13)	31.20 (26.80, 38.00)	5.365	< 0.0001
Serum cystatin C	0.83 (0.79, 0.91)	0.76 (0.72, 0.81)	0.79 (0.75, 0.85)	3.822	0.0002
Urinary α1-microglobulin	6.36 (4.80, 9.31)	4.07 (1.82, 6.92)	5.62 (2.89. 8.38)	2.068	0.042
Urine N-acetyl-beta-D-glucosaminidase	7.73 (5.62, 10.5)	7.99 (3.50, 11.18)	7.73 (4.95, 11.11)	1.027	0.307
Urine cystatin	0.15 (0.10, 0.21)	0.14 (0.09, 0.20)	0.14 (0.09, 0.21)	0.347	0.729

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir; ALT: Alanine aminotransferase; HBV: Hepatitis B virus.

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Table 2 Comparison of baseline index abnormality rates (n = 95), n (%)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	χ² value	P value
ALT abnormality rate	10 (22.2)	7 (14.0)	17 (17.9)	1.090	0.297
Prevalence of low bone mass	5 (11.1)	9 (18.0)	14 (14.7)	0.895	0.344
Blood urea abnormality rate	2 (4.4)	0 (0.0)	2 (2.1)	2.270	0.132
Serum creatinine abnormality rate	5 (11.1)	9 (18.0)	14 (14.7)	0.895	0.344
Serum retinol-binding protein abnormality rate	7 (15.6)	9 (18.0)	16 (16.8)	0.101	0.751
Serum cystatin C abnormality rate	2 (4.4)	0 (0.0)	2 (2.1)	2.270	0.132
Urinary α1-microglobulin abnormality rate	7 (15.6)	5 (10.0)	12 (12.6)	0.662	0.416
Urine N-acetyl-beta-D-glucosaminidase abnormality rate	10 (22.2)	11 (22.0)	21 (22.1)	0.001	0.979
Urine cystatin abnormality rate	7 (15.6)	7 (14.0)	14 (14.7)	0.046	0.831

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir; ALT: Alanine aminotransferase.

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Table 3 Inter-group comparison of bone and renal safety indexes at the 48-week follow-up, mean ± SD/median (Q1, Q3)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	t value	P value
Serum calcium	2.42 ± 0.38	2.31 ± 0.15	2.36 ± 0.28	1.499	0.140
Serum phosphorus	1.06 ± 0.14	1.00 ± 0.18	1.02 ± 0.17	1.190	0.239
Serum 25-hydroxyvitamin D₃	24.26 ± 9.74	22.74 ± 9.37	23.59 ± 9.51	0.555	0.581
Blood urea	4.79 (4.12, 6.30)	5.22 (4.29, 6.35)	5.03 (4.14, 6.35)	1.473	0.144
Serum creatinine	61.00 (53.00, 71.00)	62.00 (53.25, 68.75)	61.00 (53.00, 70.50)	0.182	0.856
Serum retinol-binding protein	43.5 (32.1, 50.3)	37.55 (33.38, 41.05)	38.60 (32.80, 45.85)	0.895	0.373
Serum cystatin C	0.79 (0.69, 0.91)	0.77 (0.67, 0.85)	0.78 (0.69, 0.88)	1.422	0.158
Urinary α1-microglobulin	8.14 (5.74, 9.40)	5.26 (3.25, 6.89)	6.26 (4.30, 9.00)	2.024	0.046
Urine N-acetyl-beta-D-glucosaminidase	7.85 (6.15, 9.70)	5.01 (3.56, 6.80)	6.42 (4.21, 9.33)	1.209	0.230
Urine cystatin	0.16 (0.12, 0.18)	0.14 (0.10, 0.21)	0.15 (0.11, 0.19)	0.345	0.731

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir.

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Table 4 Abnormality rates of bone and renal safety indexes at 48-week follow-up, n (%)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	χ² value	P value
Prevalence of low bone mass	5 (11.1)	9 (18.0)	14 (14.7)	0.891	0.344
Blood urea abnormality rate	4 (8.9)	3 (6.0)	7 (7.4)	0.290	0.591
Serum creatinine abnormality rate	1 (2.2)	3 (6.0)	4 (4.2)	0.838	0.360
Serum retinol-binding protein abnormality rate	5 (11.1)	4 (8.0)	9 (9.5)	0.267	0.605
Serum cystatin C abnormality rate	7 (15.6)	5 (10.0)	12 (12.6)	0.662	0.416
Urinary α1-microglobulin abnormality rate	3 (6.7)	3 (6.0)	6 (6.3)	0.018	0.894
Urine N-acetyl-beta-D-glucosaminidase abnormality rate	7 (15.6)	6 (12.0)	13 (13.7)	0.254	0.615
Urine cystatin abnormality rate	3 (6.7)	8 (16.0)	11 (11.6)	2.015	0.156

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir.

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Table 5 Inter-group comparison of bone and renal safety indexes at the 96-week follow-up, mean ± SD/median (Q1, Q3)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	t value	P value
Serum calcium	2.33 ± 0.12	2.41 ± 0.47	2.37 ± 0.35	0.637	0.529
Serum phosphorus	1.11 ± 0.40	1.00 ± 0.16	1.06 ± 0.30	0.945	0.353
Serum 25-hydroxyvitamin D₃	22.15 ± 7.23	25.18 ± 10.11	23.78 ± 8.86	0.863	0.397
Blood urea	4.63 (3.94, 4.94)	4.57 (3.89, 5.22)	4.57 (3.94, 5.18)	0.258	0.797
Serum creatinine	62.00 (59.00, 67.00)	66.00 (58.00, 73.50)	64.00 (58.00, 70.50)	0.890	0.376
Serum retinol-binding protein	48.10 (39.30, 53.70)	42.15 (35.23, 44.90)	43.00 (37.00, 49.40)	0.867	0.388
Serum cystatin C	0.69 (0.52, 0.81)	0.72 (0.67, 0.88)	0.70 (0.66, 0.87)	1.745	0.084
Urinary α1-microglobulin	6.42 (5.27, 7.40)	7.52 (5.71, 9.44)	6.84 (5.34, 8.32)	2.022	0.046
Urine N-acetyl-beta-D-glucosaminidase	6.54 (5.60, 7.25)	8.48 (6.56, 9.96)	7.45 (6.03, 9.11)	3.193	0.002
Urine cystatin	0.11 (0.08, 0.13)	0.14 (0.12, 0.17)	0.13 (0.11, 0.15)	3.561	0.001

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir.

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Table 6 Abnormality rates of bone and renal safety indexes at the 96-week follow-up, n (%)

General information	TAF group (n = 45)	ETV group (n = 50)	Total (n = 95)	χ² value	P value
Prevalence of low bone mass	5 (11.1)	11 (22.0)	16 (16.8)	2.005	0.157
Blood urea abnormality rate	3 (6.7)	4 (8.0)	7 (7.4)	0.062	0.804
Serum creatinine abnormality rate	3 (6.7)	5 (10.0)	8 (8.4)	0.341	0.559
Serum retinol-binding protein abnormality rate	5 (11.1)	9 (18.0)	14 (14.7)	0.891	0.344
Serum cystatin C abnormality rate	6 (13.3)	11 (22.0)	17 (17.9)	1.211	0.271
Urinary α1-microglobulin abnormality rate	2 (4.4)	10 (20.0)	12 (12.6)	5.193	0.023
Urine N-acetyl-beta-D-glucosaminidase abnormality rate	3 (6.7)	12 (24.0)	15 (15.8)	5.352	0.021
Urine cystatin abnormality rate	2 (4.4)	9 (18.0)	11 (11.6)	4.251	0.039

TAF: Tenofovir alafenamide fumarate; ETV: Entecavir.

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Citation: Ning HB, Jin HM, Peng Z, Li K, Shang J. Bone and renal safety of initial antiviral therapy using tenofovir alafenamide fumarate or entecavir for chronic hepatitis B. World J Gastroenterol 2026; 32(22): 117500
URL: https://www.wjgnet.com/1007-9327/full/v32/i22/117500.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i22.117500

Ning HB, Jin HM, Peng Z, Li K, Shang J. Bone and renal safety of initial antiviral therapy using tenofovir alafenamide fumarate or entecavir for chronic hepatitis B. World J Gastroenterol 2026; 32(22): 117500 [DOI: 10.3748/wjg.v32.i22.117500]

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