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

Sara Yee Tartof, Jin-Wen Hsu, Rong Wei, Kevin B. Rubenstein, Haihong Hu, Jean Marie Arduino, Michael Horberg, Stephen F. Derose, Lei Qian and Carla V. Rodriguez
CJASN October 2018, 13 (10) 1471-1478; DOI: https://doi.org/10.2215/CJN.01530218
Sara Yee Tartof
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
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Jin-Wen Hsu
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
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Rong Wei
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
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Kevin B. Rubenstein
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland; and
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Haihong Hu
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland; and
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Jean Marie Arduino
Jean Marie Arduino, Center for Observational and Real-world Evidence, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey
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Michael Horberg
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland; and
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Stephen F. Derose
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
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Lei Qian
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
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Carla V. Rodriguez
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland; and
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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.

  • chronic kidney disease
  • clinical epidemiology
  • end-stage renal disease
  • Epidemiology and outcomes
  • ESRD
  • hepatitis
  • glomerular filtration rate
  • Proportional Hazards Models
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Kidney Failure, Chronic
  • Hepatitis C
  • Disease Progression
  • Received February 2, 2018.
  • Accepted July 27, 2018.
  • Copyright © 2018 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 13 (10)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 10
October 08, 2018
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Kidney Function Decline in Patients with CKD and Untreated Hepatitis C Infection
Sara Yee Tartof, Jin-Wen Hsu, Rong Wei, Kevin B. Rubenstein, Haihong Hu, Jean Marie Arduino, Michael Horberg, Stephen F. Derose, Lei Qian, Carla V. Rodriguez
CJASN Oct 2018, 13 (10) 1471-1478; DOI: 10.2215/CJN.01530218

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Kidney Function Decline in Patients with CKD and Untreated Hepatitis C Infection
Sara Yee Tartof, Jin-Wen Hsu, Rong Wei, Kevin B. Rubenstein, Haihong Hu, Jean Marie Arduino, Michael Horberg, Stephen F. Derose, Lei Qian, Carla V. Rodriguez
CJASN Oct 2018, 13 (10) 1471-1478; DOI: 10.2215/CJN.01530218
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More in this TOC Section

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Keywords

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

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