405 HARPE STUDY: PREVALENCE OF RENAL ABNORMALITIES IN CHRONIC HBV INFECTION

Abstract

Background and Aims: A close relationship exists between HBV infection and renal dysfunction. This study was undertaken to evaluate the degree of renal dysfunction in HBV positive patients in a university hospital in Mumbai and factors predicting it. Methods: We retrospectively analyzed 663 HBV positive patients presenting to our clinic from January 2010-June 2012 for renal dysfunction (estimated Glomerular Filtration rate (eGFR) by MDRD formula). Excluding 13 patients on maintenance hemodialysis and 66 with missing data, 584 patients (467 males; median age 43, range 9–80 years) were included. Results: Of 584 patients, 24 had acute hepatitis, 209 non-cirrhotic Chronic Hepatitis B (CHB), 214 were inactive carriers, 108 had CHB with cirrhosis, 22 were in immunotolerant phase, 6 had acuteon-chronic liver failure, 1 patient post liver transplant. Majority of patients were HBeAg negative (74.82%). 141 patients (24.1%) had comorbidities (diabetes mellitus and/or systemic hypertension). Serum creatinine was elevated (>1.5mg/ml) in 20 patients (2.7%) while eGFR (MDRD) was below normal ( 90ml/min/1.72m, 293 patients. Based on HBV disease status, renal function was different: In acute group (acute hepatitis, immunotolerant), 26.53% patients had mild renal dysfunction (eGFR 60–90ml/min/1.72m) versus chronic disease group (inactive carrier status, CHB, cirrhosis, others) with 44.49% (p =0.008). In multivariate analysis, age, gender, hypertension and chronic disease stage had significant association with reduced eGFR. 1 year follow-up eGFR values were available for 321 patients, of which 79 (25%) showed worsening of renal function by >20% while 58 patients (15%) showed >20% improvement. Within the cirrhotic population, Diabetes was significantly more prevalent than in other populations (33% of patients). 62/108 (57%) of cirrhotic patients had reduced renal function. Conclusion: HBV infection is associated with significant degree of reduced renal function, reaching up to 50% in the chronic population of our clinic. Comorbidities (25%) or antiviral treatment might further increase renal risk, therefore regular monitoring of renal function is recommended. MDRD formula was shown to be more sensitive than serum creatinine for renal function evaluation.