HCV Infection Raises Kidney Failure Risk

Hepatitis C virus infection increases CKD patients' likelihood of progressing to ESRD by 32%.
Hepatitis C virus infection increases CKD patients' likelihood of progressing to ESRD by 32%.
Hepatitis C virus (HCV) infection is associated with an increased risk of end-stage renal disease (ESRD) in patients with chronic kidney disease, according to a new study.

Jia-Jung Lee, MD, Kaohsiung Medical University, Kaohsiung, Taiwan, and colleagues enrolled a prospective cohort of 4,185 patients with chronic kidney disease (CKD). Of these, 317 had HCV infection and 3,868 did not. The prevalence of HCV infection was 7.6% and it increased with CKD stage.  During a follow-up of 9,101 person-years of follow-up, 446 patients died and 1,205 progressed to ESRD. The rates of ESRD and death (per 100 patient-years) were 13.2% and 4.9%, respectively.

In a death-adjusted competing risk analysis, the estimated 5-year cumulative incidence rate of ESRD among patients with and without HCV infection were 52.6% and 38.4%, respectively. In multivariable analysis, HCV infection was associated with a 32% increased risk of ESRD compared with the absence of HCV infection, the investigators reported in PLoS One (2014;e100790). The study revealed no significant association between hepatitis B infection and ESRD risk. Results also showed that HCV infected patients were significantly older than non-infected patients (mean 64.5 vs. 61.7 years). The HCV infected group also had a significantly higher proportion of women (52.4% vs. 40.6%).

In a previous meta-analysis published in the Clinical Journal of the American Society of Nephrology (2012;7:549-557),  Fabrizio Fabrizi, MD, of Maggiore Policlinico in Milan, Italy, and collaborators demonstrated that HCV is independently associated  with proteinuria but not decreased glomerular filtration rate in the general population. In a report published in BMC Nephrology (2013;14:187), Yi-Chun Chen, MD, of Tzu Chi University, Hualien, Taiwan, and colleagues concluded that HCV is a causal risk factor for CKD beyond traditional risk factors. They based their conclusion on a 6-year cohort study that included 3,182 individuals with newly diagnosed HCV infection and no traditional CKD risk factors and 12,728 randomly selected matched controls without HCV infection. In multivariate analysis, the HCV-infected group had a significant 75% increased risk of CKD compared with the HCV-uninfected group.

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