Association of hepatitis C viral infection with incidence and progression of chronic kidney disease in a large cohort of US veterans.
Association of hepatitis C viral infection with incidence and progression of chronic kidney disease in a large cohort of US veterans.
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DOI：
10.1002/hep.27664
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发表时间：
2015-05
期刊：
影响因子：
13.5
通讯作者：
Kovesdy, Csaba P.
中科院分区：
文献类型：
--
作者：
Molnar, Miklos Z.;Alhourani, Hazem M.;Wall, Barry M.;Lu, Jun L.;Streja, Elani;Kalantar-Zadeh, Kamyar;Kovesdy, Csaba P.
估计有400万美国人暴露于丙型肝炎病毒（HCV）。感染HCV的肾功能正常患者发生和进展性慢性肾脏疾病以及死亡的风险尚不清楚。在100,518名HCV+和920,531名基线肾小球滤过率（eGFR）正常的HCV-美国退伍军人的全国代表性队列中，我们研究了HCV感染与：(1)全因死亡率，(2)肾功能下降发生率（定义为eGFR <60 ml/min/1.73m2和eGFR下降25%），(3)ESRD和(4)肾功能下降率的关系。在naïve和调整的Cox模型（用于事件时间分析）和逻辑回归模型（用于斜率）中检查相关性，并对重要混杂因素进行顺序调整。敏感性分析采用倾向匹配队列分析。患者年龄为54.5±13.1（mean±SD）岁，22%为黑人，92%为男性，基线eGFR为88±16 ml/min/1.73m2。在多因素校正模型中，HCV感染与死亡率高2.2倍相关（完全校正风险比（aHR）， 95%CI: 2.17(2.13-2.21)），肾功能下降发生率高15% (aHR, 95%CI: 1.15(1.12-1.17))， eGFR斜率更陡的风险高22%（校正优势比，95%CI: 1.22(1.19-1.26)）， ESRD风险高98% （aHR, 95%CI: 1.98(1.81-2.16)）。在倾向匹配的队列分析中也发现了类似的定量结果。HCV感染与较高的死亡风险、肾功能下降的发生率和肾功能的进行性丧失相关。有必要进行随机对照试验，以确定HCV感染的治疗是否可以预防CKD的发生和进展，并改善患者的预后。
An estimated 4 million Americans have been exposed to the hepatitis C virus (HCV) in the US population. The risk of incident and progressive chronic kidney disease and of mortality in patients with normal kidney function infected with HCV is 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/1.73m2 and 25% decrease in eGFR), (3)ESRD, and (4)rate of kidney function decline. Associations were examined in naïve 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±SD) years, 22% were black and 92% male, and the baseline eGFR was 88±16 ml/min/1.73m2. In multivariate adjusted models HCV infection was associated with 2.2 fold higher mortality (fully adjusted hazard ratio(aHR), 95%CI: 2.17(2.13–2.21)), 15% higher incidence of decreased kidney function(aHR, 95%CI: 1.15(1.12–1.17)), 22% higher risk of steeper slopes of eGFR (adjusted odds ratio, 95%CI: 1.22(1.19–1.26)) and 98% higher hazard of ESRD (aHR, 95%CI: 1.98 (1.81–2.16)). Quantitatively similar results were found in propensity-matched cohort analyses. HCV infection 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 CKD and improve patient outcomes.
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