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2015 ; 61
(5
): 1495-502
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Association of hepatitis C viral infection with incidence and progression of
chronic kidney disease in a large cohort of US veterans
#MMPMID25529816
Molnar MZ
; Alhourani HM
; Wall BM
; Lu JL
; Streja E
; Kalantar-Zadeh K
; Kovesdy CP
Hepatology
2015[May]; 61
(5
): 1495-502
PMID25529816
show ga
An estimated 4 million Americans have been exposed to the hepatitis C virus
(HCV). The risks of incident and progressive chronic kidney disease and of
mortality in patients with normal kidney function infected with HCV are unclear.
In a nationally representative cohort of 100,518 HCV(+) and 920,531 HCV(-) US
veterans with normal baseline estimated glomerular filtration rate (eGFR), we
examined the association of HCV infection with (1) all-cause mortality, (2)
incidence of decreased kidney function (defined as eGFR <60 mL/min/1.73 m(2) and
25% decrease in eGFR), (3) end-stage renal disease, and (4) rate of kidney
function decline. Associations were examined in naive and adjusted Cox models
(for time-to-event analyses) and logistic regression models (for slopes), with
sequential adjustments for important confounders. Propensity-matched cohort
analysis was used in sensitivity analyses. The patients' age was 54.5?±?13.1
(mean?±?standard deviation) years, 22% were black, 92% were male, and the
baseline eGFR was 88?±?16 mL/min/1.73 m(2) . In multivariable adjusted models HCV
infection was associated with a 2.2-fold higher mortality (fully adjusted hazard
ratio?=?2.17, 95% confidence interval [CI] 2.13-2.21), a 15% higher incidence of
decreased kidney function (adjusted hazard ratio?=?1.15, 95% CI 1.12-1.17), a 22%
higher risk of steeper slopes of eGFR (adjusted odds ratio?=?1.22, 95% CI
1.19-1.26), and a 98% higher hazard of end-stage renal disease (adjusted hazard
ratio?=?1.98, 95% CI 1.81-2.16). Quantitatively similar results were found in
propensity-matched cohort analyses. CONCLUSIONS: Infection with HCV is associated
with higher mortality risk, incidence of decreased kidney function, and
progressive loss of kidney function; randomized controlled trials are warranted
to determine whether treatment of HCV infection can prevent the development and
progression of chronic kidney disease and improve patient outcomes.