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

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.