Higher prevalence of Chronic Kidney Disease and Poor Renal Survival in Patients with Chronic HCV Infection

Abstract

Purpose: Hepatitis C is more prevalent in patients with end-stage renal disease (ESRD) than in the general population. It is not clear whether HCV by itself plays an important role in the etiology of chronic kidney disease (CKD). We aimed to measure the prevalence of CKD and evaluate its course in patients with chronic HCV infection. Methods: A total of 559 anti-HCV positive patients were compared with 323 anti-HCV negative patients matched for age, race, and sex who were seen in the general GI clinic. CKD was defined by either persistence of proteinuria on urine analysis by dipstick and/or a serum creatinine of >1.5 mg/dL in men or >1.3 mg/dL in women for more than 3 months. Patients with nephrolithiasis and structural kidney disease were excluded from the analysis. Viral load obtained during the initial evaluation was defined as “baseline viral load”. Results: The prevalence of CKD in the anti-HCV positive group was significantly higher as compared to the control group [37 (6.6%) vs. 11 (3.4%), p=0.043. Prevalence of DM [105 (18.8%) vs. 55 (17%), p=0.515] and hypertension [222 (39%) vs. 124 (35.5%), p=0.642] were comparable in both groups. Only 4 of the 37 (10.8%) patients with CKD had received interferon therapy before development of CKD compared to 157 of 531 (30.1%) patients without CKD (p= 0.012). A significantly higher baseline viral load was noted in patients with chronic HCV infection with CKD compared to patients without CKD (5.78cps/ml ± 2.57 vs. 4.49 cps/ml ± 2.57, p=0.006). Logistic regression analysis revealed baseline viral load (p=0.043, OR=1.196; CI: 1.005-1.422), body weight (p=0.016, OR=0.966, CI: 0.940-0.994), and hypertension (p=0.018, OR=0.280; CI: 0.097-0.807) were significant predictors of CKD. Age, gender, HIV status, DM, IVDU and HCV genotype were not predictors of CKD in this study.Renal survival was significantly shorter in patients with chronic HCV infections compared to age, race and sex matched control population (p= 0.014). Conclusion: The prevalence of CKD was significantly higher among patients with chronic HCV infection compared to controls and leads to a significantly shorter renal survival. A higher baseline viral load is an independent predictor of CKD in addition to the components of metabolic syndrome.