Association of hepatitis C viral infection with incidence and progression of chronic kidney disease in a large cohort of US veterans

Abstract

Background An estimated 4 million Americans have been exposed to the hepatitis C virus (HCV) in the US population. The risk of incident and progressive chronic kidney disease and of mortality in patients with normal kidney function infected with HCV is unclear. Methods In a nationally representative cohort of 100,518 HCV+ and 920,531 HCV- US Veterans with normal baseline estimated glomerular filtration rate(eGFR), we examined the association of HCV infection with: (1)all-cause mortality, (2)incidence of decreased kidney function (defined as eGFR <60 ml/min/1.73m2 and 25% decrease in eGFR), (3)ESRD, and (4)rate of kidney function decline. Associations were examined in naïve and adjusted Cox models (for time-to-event analyses) and logistic regression models (for slopes), with sequential adjustments for important confounders. Propensity-matched cohort analysis was used in sensitivity analyses. Results The patients’ age was 54.5±13.1(mean±SD) years, 22% were black and 92% male, and the baseline eGFR was 88±16 ml/min/1.73m2. In multivariate adjusted models HCV infection was associated with 2.2 fold higher mortality (fully adjusted hazard ratio(aHR), 95%CI: 2.17(2.13–2.21)), 15% higher incidence of decreased kidney function(aHR, 95%CI: 1.15(1.12–1.17)), 22% higher risk of steeper slopes of eGFR (adjusted odds ratio, 95%CI: 1.22(1.19–1.26)) and 98% higher hazard of ESRD (aHR, 95%CI: 1.98 (1.81–2.16)). Quantitatively similar results were found in propensity-matched cohort analyses. Conclusions HCV infection is associated with higher mortality risk, incidence of decreased kidney function and progressive loss of kidney function. Randomized controlled trials are warranted to determine whether treatment of HCV infection can prevent the development and progression of CKD and improve patient outcomes.

Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

“…Data were obtained from the Racial and Cardiovascular Risk Anomalies in chronic kidney disease (CKD; RCAV) study, which examines risk factors of incident CKD, mortality, and other outcomes in US veterans, and which was previously described in detail [16,17].…”

Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost

“…Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD There is an established relationship between HCV and CKD. Patients with HCV are at risk of developing certain types of renal disease (e.g., mixed cryoglobulinemia with membranoproliferative glomerulonephritis) [11] and may be more likely to develop CKD [12] , and CKD may progress faster in patients with HCV than in those without HCV [13][14][15] . In ESRD patients on maintenance dialysis, the prevalence of HCV increases with dialysis duration [16] , potentially due to transmission from blood products or contaminated equipment [11] .…”

Hepatitis C Virus Infection in Chronic Kidney Disease

“…10 Recent studies suggest that HCV-infected patients with CKD have an accelerated rate of kidney function loss and an increased risk of progressing to ESRD. [14][15][16][17][18][19] In one study, Molnar et al 19 showed that HCVinfected patients with CKD had an increased mortality and an accelerated rate of progression to ESRD, raising the important question of whether treating to obtain a sustained virologic response defined as an undetectable viral load 12 weeks after completion of treatment (SVR12) would diminish the rate of decline in GFR.…”