Kidney Function Decline in Patients with CKD and Untreated Hepatitis C Infection

Abstract

Background and objectives: Studies evaluating the role of hepatitis C viral (HCV) infection on the progression of CKD are few and conflicting. Therefore, we evaluated the association of untreated HCV on kidney function decline in patients with stage 3-5 CKD.

Design, setting, participants, & measurements: This retrospective cohort study included members of Kaiser Permanente Southern California and Kaiser Permanente Mid-Atlantic States aged ≥18 years, with incident HCV and CKD diagnoses from January 1, 2004 to December 31, 2014. We used generalized estimating equations to compare the rate of change in eGFR between those with HCV and CKD versus CKD alone, adjusting for covariates. Cox proportional hazards models compared the risk of 25% decrease in eGFR and ESKD (defined as progression to eGFR<15 ml/min per 1.73 m² on two or more occasions, at least 90 days apart) in those with HCV and CKD versus CKD alone, adjusting for covariates.

Results: We identified 151,974 patients with CKD only and 1603 patients with HCV and CKD who met the study criteria. The adjusted annual decline of eGFR among patients with HCV and CKD was greater by 0.58 (95% confidence interval [95% CI], 0.31 to 0.84) ml/min per 1.73 m², compared with that in the CKD-only population (HCV and CKD, -1.61; 95% CI, -1.87 to -1.35 ml/min; CKD only, -1.04; 95% CI, -1.06 to -1.01 ml/min). Adjusted for covariates, the hazard for a 25% decline in eGFR and for ESKD were 1.87 (95% CI, 1.75 to 2.00) and 1.93 (95% CI, 1.64 to 2.27) times higher among those with HCV and CKD, respectively, compared with those with CKD only.

Conclusions: Untreated HCV infection was associated with greater kidney function decline in patients with stage 3-5 CKD.

Keywords: Disease Progression; ESRD; Epidemiology and outcomes; Hepatitis C; Kidney Failure, Chronic; Proportional Hazards Models; Renal Insufficiency, Chronic; Retrospective Studies; chronic kidney disease; clinical epidemiology; end-stage renal disease; glomerular filtration rate; hepatitis.

Graphical abstract

Figure 1.

Application of exclusion criteria to obtain final study population. Some patients met more than one exclusion criterion.

Figure 2.

Adjusted annual decline in eGFR in patients with HCV and CKD and those with CKD alone. Adjusted for age, sex, race/ethnicity, CKD stage, diabetes, hypertension, HIV, hepatitis B infection, myocardial infarction, end-stage liver disease; and interactions between time and HCV and CKD status, diabetes, hepatitis B virus, and race.