Association of hepatitis C virus infection with prevalence and development of kidney disease
Association of hepatitis C virus infection with prevalence and development of kidney disease
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DOI：
10.1053/j.ajkd.2008.03.009
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发表时间：
2008-06-01
影响因子：
13.2
通讯作者：
Hui, Siu L.
中科院分区：
文献类型：
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作者：
Moe, Sharon M.;Pampalone, A. J.;Hui, Siu L.
背景：丙型肝炎和慢性肾脏病（CKD）在美国都是高度流行的疾病。数据显示，丙型肝炎可能与某些肾小球疾病有因果关系，丙型肝炎阳性患者发生蛋白尿的风险增加。研究设计：为了确定丙型肝炎感染是否与CKD的可能性增加有关，我们对一个大型临床数据库进行了回顾性横断面和纵向分析。1994年至2004年期间对13，139名非裔美国人和白色患者进行丙型肝炎检测的研究人群的数据从城市医院和附属诊所临床人群的计算机数据库中提取。在横断面分析中，CKD定义为使用4变量同位素稀释质谱法可追踪的肾脏疾病饮食改良研究方程或蛋白尿，估计的肾小球滤过率（eGFR）最小值小于60 mL/min/1.73 m（2）。在纵向分析中，CKD定义为eGFR小于60 mL/min/1.73 m2。测量：研究的潜在混杂因素包括性别、年龄、种族、人类免疫缺陷病毒（HIV）状态、慢性高血压、糖尿病和其他实验室检查结果异常。在CKD患者中，1，999例（78.4%）eGFR低于60 mL/min/1.73 m（2），186例（7.3%）有蛋白尿，364例（14.3%）两者兼有。在横断面分析中，在控制糖尿病、高血压、年龄、天冬氨酸转氨酶水平和HIV状态后，丙型肝炎检测阳性的患者CKD风险降低（比值比，0.69; 95%置信区间，0.62至0.77）。共对7，038例无CKD的受试者进行了中位3.5年的随访。其中，2，243例（31.8%）在随访开始时为丙型肝炎阳性。在纵向分析中，校正年龄、基线eGFR、糖尿病、高血压、天冬氨酸转氨酶水平和HIV状态后，CKD与丙型肝炎阴性患者相比的风险比为0.896（95%置信区间，0.790至1.015）。局限性：回顾性设计，临床数据库缺失值，研究期间使用的不同丙型肝炎检测方法，蛋白尿数据有限。结论：我们的研究结果不支持丙型肝炎病毒感染本身与CKD风险增加相关的假设。
Background: Hepatitis C and chronic kidney disease (CKD) are both highly prevalent diseases in the United States. Data showed that hepatitis C may be causally linked to some glomerular diseases, and patients who are positive for hepatitis C have increased risk of albuminuria.Study Design: To determine whether hepatitis C infection is associated with increased likelihood of CKD, we performed retrospective cross-sectional and longitudinal analyses of a large clinical database.Setting & Participants: Data for a study population of 13,139 African American and white patients tested for hepatitis C between 1994 and 2004 were extracted from a computerized database from a clinical population of an urban hospital and affiliated clinics.Predictor: Hepatitis C by means of enzyme-linked immunosorbent assay.Outcome: In cross-sectional analysis, CKD was defined as a minimum estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2) by using the 4-variable isotope dilution mass spectrometry-traceable Modification of Diet in Renal Disease Study equation or proteinuria. In longitudinal analysis, CKD was defined as eGFR less than 60 mL/min/1.73 m(2).Measurements: Potential confounders investigated included sex, age, race, human immunodeficiency virus (HIV) status, chronic hypertension, diabetes, and other laboratory test result abnormalities.Results: 3,938 patients (30.0%) were positive for hepatitis C and 2,549 (19.4%) had CKD. Of those with CKD, 1,999 (78.4%) had an eGFR less than 60 mL/min/1.73 m(2), 186 (7.3%) had proteinuria, and 364 (14.3%) had both. In cross-sectional analysis, after controlling for diabetes, hypertension, age, aspartate aminotransferase level, and HIV status, patients who tested positive for hepatitis C had a decreased risk of CKD (odds ratio, 0.69; 95% confidence interval, 0.62 to 0.77). A total of 7,038 subjects without CKD were followed up for a median of 3.5 years. Of these, 2,243 (31.8%) were hepatitis C positive at the onset of follow-up. In longitudinal analysis, after adjustment for age, baseline eGFR, diabetes, hypertension, aspartate aminotransferase level, and HIV status, the hazard ratio for the development of CKD compared with those who were hepatitis C negative was 0.896 (95% confidence interval, 0.790 to 1.015).Limitations: Retrospective design, clinical database with missing values, different hepatitis C assays used during the study period, limited data for proteinuria.Conclusions: Our results do not support the hypothesis that infection with hepatitis C virus per se is associated with increased risk of having or developing CKD.