Greater Risk for Chronic Kidney Disease in Untreated HCV

Patients with hepatitis C virus (HCV) are at a greater risk for chronic kidney disease (CKD), membranoproliferative glomerulonephritis (MPGN), and cryoglobulinemia, but some forms of treatment can prevent CKD, according to data published in Hepatology.

A retrospective cohort study was performed to determine the risk for CKD, MPGN, and cryoglobulinemia in patients with chronic HCV, along with the reduction in incidence of CKD after treatment. Chronic HCV infection is associated with extrahepatic manifestations, with CKD being one of the most commonly reported.

After propensity score matching, a total of 56,448 patients with HCV and 169,344 patients without HCV were identified, in whom crude incidence rates of CKD were 10.36 per 1000 person-years and 5.72 per 1000 person-years in each group, respectively.  

Using a multivariate time-varying Cox regression model that took into account changes in comorbidities and medication, a 27% increased risk (hazard ratio [HR] 1.27; 95% CI, 1.18-1.37) for CKD was found in patients with HCV. Risks were also more significant in adults age 18 to 49 compared with adults age ≥60. Compared with patients without HCV, there was a 2-fold and a nearly 17-fold higher risk for MPGN (HR 2.23; 95% CI, 1.84-2.71) and cryoglobulinemia (HR 16.91; 95% CI, 12.00-23.81), respectively, in patients with HCV.

Patients with HCV receiving minimally effective interferon-based dual (n=3666), triple (n=3534), and all-oral (n=4628) direct-acting antivirals (DAAs) had a 30% decreased risk for CKD (HR 0.70; 95% CI, 0.55-0.88).

This study highlighted that early treatment of HCV can reduce risk for CKD, and researchers were “disturbed” to find that 79% of patients with chronic HCV did not receive treatment.

More research is needed to identify barriers to identifying patients with HCV and improving access to treatment, concluded the investigators. In addition, a longer study period would allow for a full exploration into the use of DAAs in the development and progression of CKD.

Reference

Park H, Chen C, Wang W, Henry L, Cook RL, Nelson DR. Chronic hepatitis C increases the risk of chronic kidney disease (CKD) while effective HCV treatment decreases the incidence of CKD [published online September 5, 2017]. Hepatology. doi:10.1002/hep.29505