Abstract
Hepatitis C virus (HCV) infection greatly increases the risk of nephropathy. In this observational study, we aimed to explore the relationship between viral hepatitis infection and chronic kidney disease (CKD), identify risk factors, and determine the effect of antiviral treatment on CKD in Chinese patients with chronic HCV infection. A total of 2,435 study subjects were enrolled and divided into four groups: the HCV infection, HBV infection, HBV and HCV co-infection, and uninfected control groups. Of these, 207 patients with chronic hepatitis C (CHC) were given standard dual therapy [subcutaneous injection of recombinant interferon (IFN)-α2b and oral ribavirin (RBV)] for 48 weeks. We found that the prevalence of CKD gradually increased with age in all groups and was significantly increased in patients 60 years or older. Multivariate logistic regression analyses showed that persistent HCV infection was significantly associated with CKD [odds ratio (OR), 1.33; 95% confidence interval (CI), 1.06–1.66; P = 0.013], whereas there was no significant link between CKD and spontaneous HCV clearance (OR, 1.23; 95% CI, 0.79–1.90; P = 0.364), HBV infection (OR, 0.73; 95% CI, 0.44–1.19; P = 0.201), or HBV/HCV co-infection (OR, 1.40; 95% CI, 0.81–2.40; P = 0.234). Notably, after anti-HCV therapy, the serum creatinine concentration was significantly decreased (76.0, 75.5–79.4 μmol/L) from the pretreatment level (95.0, 93.0–97.2 μmol/L), both in patients who showed an end of treatment virological response (ETVR) and those who did not (P < 0.001). Also, in both the ETVR and non-ETVR groups, the percentages of patients with an estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73 m2 increased significantly (P < 0.001), whereas the percentages of those with an eGFR <60 ml/min/1.73 m2 significantly decreased (P < 0.001). In conclusion, persistent HCV infection was independently associated with CKD, and antiviral treatment with IFN plus RBV can improve renal function and reverse CKD in HCV-infected patients.
Highlights
An updated meta-analysis demonstrated a significant increase in the risk of chronic kidney disease (CKD) among Hepatitis C virus (HCV)-infected patients in comparison with uninfected individuals[8,9]
The HCV infection group had an older mean age (54.6 ± 8.7 years), higher rates of diabetes mellitus (10.8%) and CKD (32.1%), and higher levels of hemoglobin [152 (140–163) g/L], alanine aminotransferase (ALT) [38 (23–72) U/L], total bilirubin [13.8 (9.9–18.5) μmol/L], serum urea nitrogen (SUN) [5.6 (4.6–6.7) mmol/L], and serum creatinine (Scr) [67.0 (58.0–76.4) μmol/L] compared to the HBV group, which had a mean age of 46.0 ± 10.2 years and CKD prevalence of 19.7%
We investigated the prevalence of CKD in mainland China, a high endemic area of HCV infection, for the first time and determined the risk factors associated with CKD
Summary
An updated meta-analysis demonstrated a significant increase in the risk of CKD among HCV-infected patients in comparison with uninfected individuals[8,9]. The heterogeneity of the demographic data, nature and stage of kidney disease, as well as the severity of liver injury and extrahepatic manifestations may lead to different results, and it remains unknown whether IFN-based dual therapy with IFN plus RBV, the main components of HCV treatment in mainland China due to the high cost of direct-acting antiviral agents (DAAs), can improve renal function or reverse CKD in HCV-infected patients in a Chinese population. Fuyu is an endemic area for HCV infection and provides an excellent setting for this type of study, as it is suitable for examining the relationship of IFN-based therapy for HCV with CKD due to the high prevalence of both HCV infection and anti-viral treatment[16,17]. The results gained through this study may provide critical information that will assist in the development of early intervention measures for preventing kidney damage caused by pathogenic hepatic viruses
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