Satapathy Sanjaya Kumar, Lingisetty Chandra Sekhar, Williams Susan
Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, 10029, USA.
Department of Gastroenterology, New York Medical College/Metropolitan Hospital Center, 1901 First Avenue, New York, 10029, USA.
Hepatol Int. 2012 Jan;6(1):369-78. doi: 10.1007/s12072-011-9284-9. Epub 2011 Jun 23.
The role of hepatitis C virus infection (HCV) in the etiology and progression of chronic kidney disease (CKD) is controversial.
To measure the prevalence of CKD and evaluate its course in patients with chronic HCV infection.
A retrospective analysis was done after excluding patients with nephrolithiasis, structural kidney disease, and those with missing clinical information on 552 anti-HCV-positive patients and 313 patients without known HCV infection matched for age, race, and gender. CKD was defined as estimated glomerular filtration rate value of <60 mL/min/1.73 m(2) and/or persistence of proteinuria (>3 months) on urine analysis by dipstick. Viral load obtained during the initial evaluation was defined as "baseline viral load".
The prevalence of CKD in the anti-HCV-positive group was significantly higher compared to control group [53 (9.6%) vs. 16 (5.1%), P = 0.02]. On multivariate regression analysis, higher age, hypertension, HCV PCR > 7 × 10(5) cps/mL, and diabetes mellitus were significant independent positive predictors, whereas history of interferon treatment was significant independent negative predictor for CKD. Male gender, human immunodeficiency virus status, body weight, intravenous drug use, and HCV genotype were not predictors of CKD. Analysis of renal survival through Kaplan-Meyer curves revealed significantly shorter time to develop CKD (74 vs. 84 months, P < 0.001; log rank) and end-stage renal disease (79.9 vs. 86.5 months, P = 0.005; log rank) in the HCV group compared to the control group.
Chronic HCV infection was associated with a significantly higher prevalence of CKD compared with controls, as well as significantly shorter renal survival. A higher baseline viral load is an independent predictor of CKD.
丙型肝炎病毒感染（HCV）在慢性肾脏病（CKD）的病因及病情进展中的作用存在争议。
测定CKD的患病率，并评估慢性HCV感染患者的病程。
对552例抗-HCV阳性患者及313例年龄、种族和性别相匹配的无已知HCV感染患者进行回顾性分析，排除患有肾结石、结构性肾病以及临床信息缺失的患者。CKD定义为估算肾小球滤过率<60 mL/min/1.73 m²和/或尿试纸法尿液分析显示蛋白尿持续存在（>3个月）。初次评估时获得的病毒载量定义为“基线病毒载量”。
抗-HCV阳性组的CKD患病率显著高于对照组[53例（9.6%）对16例（5.1%），P = 0.02]。多因素回归分析显示，年龄较大、高血压、HCV PCR>7×10⁵ cps/mL以及糖尿病是显著的独立阳性预测因素，而干扰素治疗史是CKD的显著独立阴性预测因素。男性、人类免疫缺陷病毒感染状况、体重、静脉吸毒以及HCV基因型不是CKD的预测因素。通过Kaplan-Meyer曲线分析肾脏生存率发现，与对照组相比，HCV组发生CKD的时间（74个月对84个月，P<0.001；对数秩检验）和终末期肾病的时间（79.9个月对86.5个月，P = 0.005；对数秩检验）显著缩短。
与对照组相比，慢性HCV感染与CKD患病率显著升高以及肾脏生存率显著缩短相关。较高的基线病毒载量是CKD的独立预测因素。
