Hepatitis C virus itself is a causal risk factor for chronic kidney disease beyond traditional risk factors: a 6-year nationwide cohort study across Taiwan

Abstract

BackgroundHepatitis C virus (HCV) infection and chronic kidney disease (CKD) have high prevalences in Taiwan and worldwide, but the role of HCV infection in causing CKD remains uncertain. This cohort study aimed to explore this association.MethodsThis nationwide cohort study examined the association of HCV with CKD by analysis of sampled claims data from Taiwan National Health Insurance Research Database from 1998 to 2004. ICD-9 diagnosis codes were used to identify diseases. We extracted data of 3182 subjects who had newly identified HCV infection and no traditional CKD risk factors and data of randomly selected 12728 matched HCV-uninfected control subjects. Each subject was tracked for 6 years from the index date to identify incident CKD cases. Cox proportional hazard regression was used to determine the risk of CKD in the HCV-infected and control groups.ResultsThe mean follow-up durations were 5.88 years and 5.92 years for the HCV-infected and control groups, respectively. Among the sample of 15910 subjects, 251 subjects (1.6%) developed CKD during the 6-year follow-up period, 64 subjects (2.0%) from the HCV-infected group and 187 subjects (1.5%) from the control group. The incidence rate of CKD was significantly higher in the HCV-infected group than in the control group (3.42 vs. 2.48 per 1000 person-years, p = 0.02). Multivariate analysis indicated that the HCV-infected group had significantly greater risk for CKD (adjusted hazard ratio: 1.75, 95% CI: 1.25-2.43, p = 0.0009). This relationship also held for a comparison of HCV-infected and HCV-uninfected subjects who were younger than 70 years and had none of traditional CKD risk factors.ConclusionsHCV infection is associated with increased risk for CKD beyond the well-known traditional CKD risk factors. HCV patients should be informed of their increased risk for development of CKD and should be more closely monitored.

Hepatitis C Virus Infection Increases the Risk of Developing Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…As an example, data on HCV RNA, the socioeconomic status, compliance with medical visits over follow-up, and substance abuse which are important potential confounders were incomplete. The link between HCV and CKD persisted (aHR 1.75; 95 % CI 1.25; 2.43, P = 0.0009) in a novel survey from Taiwan, where HCVinfected subjects with conventional risk factors for CKD (diabetes, hypertension, coronary artery disease, hyperlipidemia, and cirrhosis) were excluded [16]. Finally, our subgroup analysis with meta-regression was not able to capture all the sources of heterogeneity we have observed.…”

“…We retrieved 25 studies that met our inclusion criteria, of which two [16,17] reported outcomes from the same cohort and were excluded; a total of 23 studies were retrieved. The studies were published in 17 various articles [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and carried out in 4 countries ( Fig.…”

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

“…These associations were present in HCV‐RNA–positive (viremic) patients but not in HCV‐RNA–negative patients in our sensitivity analyses. Several previous studies found similar associations, while other studies reported opposite findings . Potential reasons for the discrepant results in these studies are their smaller sample sizes, selection bias, lack of adjustment for possible confounders, and shorter follow‐up duration .…”

“…Several studies of large databases have recently addressed the association between HCV and kidney disease with conflicting results, and a recent meta‐analysis concluded that HCV was not significantly associated with the incidence of reduced estimated glomerular filtration rate (eGFR) but was positively associated with the presence of albuminuria and proteinuria in the general population . However, several of the previous studies had limitations such as modest sample size, low event rates, selection bias, and lack of proper end point definition (e.g., the use of a single eGFR <60 mL/min/1.73 m 2 to define incident CKD) .…”

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.…”