Prevalence of renal and bone risk factors and nucleos(t)ide analogue treatment among patients with chronic hepatitis B in the United States.

Abstract

Chronic hepatitis B (CHB) can lead to serious health complications. Patients with CHB often have a higher burden of extrahepatic comorbidities such as chronic kidney disease (CKD) and osteopenia/osteoporosis (OP) compared with the general population. Understanding the burden of these comorbidities in those with CHB may facilitate the development of strategies to better support patients and guide treatment decisions. To evaluate demographic characteristics and prevalence of CKD, OP, and established risk factors for CKD and OP in patients with a confirmed diagnosis of CHB and assess prevalence of nucleos(t)ide analogue (NA) use in the United States. This study evaluated retrospective claims data from Optum's deidentified Clinformatics® Data Mart database between January 1, 2016, and March 31, 2025. Commercially and Medicare-insured adults (aged ≥18 years) with a confirmed diagnosis of CHB (≥1 inpatient or ≥2 outpatient diagnostic codes ≥30 days apart) who met continuous enrollment criteria and had no evidence of HIV infection were included. Descriptive analyses were carried out to estimate the prevalence of CKD, OP, related established risk factors, and NA treatment experience. A total of 19,176 patients with CHB meeting eligibility were identified; 73% were older than 50 years, and 53% were male. Twenty-seven percent received NA treatment during the observation period: tenofovir disoproxil fumarate was most commonly used (14%), followed by entecavir (12%) and tenofovir alafenamide (7%). More than one-quarter (30%) of patients had CKD, including 9% with stage 4 or 5 CKD. Among patients with CHB, renal risk factors were prevalent, with 80% and 27%, respectively, having risk factors for CKD related to a comorbidity or medication use. More than one-quarter (29%) of the patients had a diagnosis of OP. Risk factors for OP were also prevalent, with 72% and 60% of patients, respectively, having a risk factor for OP-driven comorbidities or medication use. The overall prevalence of renal- and bone-related comorbidities and risk factors was similar among patients treated with NAs. This study demonstrates the high burden of comorbidities among patients with CHB, with established risk factors for CKD and OP present among most individuals. Although NAs are the mainstay therapy for CHB, different safety considerations exist for each therapy, and this analysis found that fewer than one-third of patients had a history of NA use. These findings highlight the importance of considering the renal and bone safety profiles of CHB treatment options to help mitigate comorbidities and prevent complications.