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. 2014 Jun 27;9(6):e100790.
doi: 10.1371/journal.pone.0100790. eCollection 2014.

Hepatitis C virus infection increases risk of developing end-stage renal disease using competing risk analysis

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Hepatitis C virus infection increases risk of developing end-stage renal disease using competing risk analysis

Jia-Jung Lee et al. PLoS One. .

Abstract

Background: Chronic kidney disease (CKD) and hepatitis C virus (HCV) infection are closely linked and both increase patient mortality. The association of HCV and risk of developing end-stage renal disease (ESRD) has not been analyzed with competing risk model.

Method: We enrolled a prospective cohort of 4,185 patients (mean age, 62 years; 41% female) registered in the CKD integrated care program at two affiliated hospitals of Kaohsiung Medical University in Taiwan between November 11, 2002 and May 31, 2009. With competing risk model, we analyzed the association of HCV infection, defined by seropositive of anti-HCV antibody, and hepatitis B virus (HBV) infection, defined by seropositive of HBV surface antigen, with the risk of entering ESRD.

Results: The prevalence of HCV infection was 7.6% and it increased with the CKD stages (trend test, P<0.001), while the prevalence of HBV infection was 7.4% and no specific trend among CKD stages (tend test, P = 0.1). During the 9,101 person-year follow-up period, there were 446 death and 1,205 patients entering ESRD. After adjusting death as the competing risk, the estimated 5-year cumulative incidence rate of ESRD among patients with and without HCV infection were 52.6% and 38.4%, respectively (modified log-rank, P<0.001). Multivariable analysis showed that HCV infection, but not HBV infection, had higher risk of developing ESRD compared with cases without infection (HCV, HR: 1.32, 95% CI: 1.07-1.62; HBV, HR: 1.10, 95% CI: 0.89-1.35). Subgroup analyses showed consistent results.

Conclusions: With death-adjusted competing risk analysis, HCV infection is associated with an increased risk of developing ESRD in CKD cohort.

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Conflict of interest statement

Competing Interests: The co-author Ming-Lung Yu is a PLOS ONE Editorial Board member. This does not alter the authors' adherence to PLOS ONE editorial policies and criteria.

Figures

Figure 1
Figure 1. Prevalence of hepatitis B virus and hepatitis C virus infection at chronic kidney disease stages.
Different prevalence between various stages of chronic kidney disease was analyzed by trend test. The P value was <0.001 in hepatitis C infected cases, and P = 0.1 in hepatitis B virus infected cases.
Figure 2
Figure 2. Cumulative incidence of end-stage renal disease adjusted competing for death plot showed HCV infection had higher cumulative rate of end-stage renal disease than cases without HCV infection (modified log-rank, P<0.001).
Figure 3
Figure 3. Multivariable stratified subgroup analyses for the association of hepatitis C virus infection with the risk of entering end-stage renal disease.

References

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