ABSTRACT

Objective Tenofovir Disoproxil Fumarate (TDF) is effective in treating Hepatitis B Virus (HBV) but has been associated with nephrotoxicity. In contrast, Tenofovir Alafenamide Fumarate (TAF) has emerged as a safer alternative, reducing kidney exposure while maintaining antiviral efficacy. This meta-analysis evaluates improvements in kidney function following the switch from TDF to TAF.

Methods Our study was registered in PROSPERO (CRD42024565358) and included 10 randomized controlled trials (RCTs) involving 1,179 patients with Chronic Kidney Disease (CKD). We compared renal function before and after switching to TAF

Results Significant improvements in glomerular filtration rate (GFR) were observed, indicating enhanced kidney function post-switch. The findings confirm that TAF demonstrates a superior renal safety profile compared to TDF, particularly in long-term treatments.

Conclusion The clinical relevance of TAF for HBV patients with CKD aligns with current guideline shifts favoring TAF. Despite limitations such as high heterogeneity, this study supports TAF as a safer management strategy for HBV patients with CKD, demonstrating improved kidney outcomes and reduced nephrotoxicity risks. These findings support its broader use in clinical practice and highlight the need for further research on long-term renal outcomes.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was not funded.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

AbbreviationsCKDChronic Kidney DiseaseeGFREstimated Glomerular Filtration RateESRDEnd-stage renal diseaseGFRGlomerular Filtration RateHBVHepatitis B virusPeg-IFNPegInterferonRCTRandomized clinical trialTAFTenofovir alafenamideTDFTenofovir disoproxil fumarate