Department of Hepatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
Hepatol Res. 2011 Oct;41(10):946-54. doi: 10.1111/j.1872-034X.2011.00845.x. Epub 2011 Aug 24.
The aim of this retrospective cohort study is to assess the development incidence and predictive factors for chronic kidney disease (CKD) after the termination of interferon therapy in hepatitis C virus (HCV) positive Japanese patients with liver cirrhosis.
A total of 650 HCV positive, liver cirrhotic patients who were treated with interferon and showed an estimated glomerular filtration rate (eGFR) of ≥60 mL/min per 1.73 m(2) after the termination of interferon therapy were enrolled. CKD was defined as an eGFR of <60 mL/min per 1.73 m(2) . End-stage-CKD was defined as an eGFR of <15 mL/min/1.73 m(2) . The primary goal is the new development of CKD and end-stage-CKD.
Eighty-five patients developed CKD, and six patients progressed to end-stage-CKD. The development rate of CKD was 5.2% at the 5th year, 14.5% at the 10th year and 30.6% at the 15th year. Multivariate Cox proportional hazards analysis showed that CKD occurred when patients had age increments of 10 years (hazard ratio: 2.32; 95% confidence interval [CI] 1.61-3.35; P < 0.001), eGFR decrements of 10 mL/min per 1.73 m(2) (hazard ratio: 1.66; 95% CI 1.27-2.16; P < 0.001), hypertension (hazard ratio: 2.00; 95% CI 1.13-3.53; P = 0.017), diabetes (hazard ratio: 1.79; 95% CI 1.02-3.14; P = 0.042), and non-clearance of HCV (hazard ratio: 2.67; 95% CI 1.34-5.32; P = 0.005). The development rate of end-stage-CKD was 0.4% at the 5th year, 1.6% at the 10th year and 2.8% at the 15th year.
The annual incidence for CKD among cirrhotic patients with HCV was determined to be about 1.0-1.5%. In addition, the annual incidence for end-stage-CKD is one order of magnitude lower than that of CKD.
本回顾性队列研究旨在评估 HCV 阳性肝硬化患者干扰素治疗结束后慢性肾脏病（CKD）的发生发展及预测因素。
共纳入 650 例 HCV 阳性、肝硬化患者，这些患者在干扰素治疗结束后肾小球滤过率（eGFR）≥60ml/min/1.73m2。CKD 的定义为 eGFR<60ml/min/1.73m2。终末期 CKD 的定义为 eGFR<15ml/min/1.73m2。主要目标是新发生的 CKD 和终末期 CKD。
85 例患者发生 CKD，6 例患者进展为终末期 CKD。CKD 的发生率为第 5 年 5.2%，第 10 年 14.5%，第 15 年 30.6%。多变量 Cox 比例风险分析显示，当患者年龄增加 10 岁（风险比：2.32；95%置信区间[CI]：1.61-3.35；P<0.001）、eGFR 降低 10ml/min/1.73m2（风险比：1.66；95%CI：1.27-2.16；P<0.001）、高血压（风险比：2.00；95%CI：1.13-3.53；P=0.017）、糖尿病（风险比：1.79；95%CI：1.02-3.14；P=0.042）和未清除 HCV（风险比：2.67；95%CI：1.34-5.32；P=0.005）时，CKD 发生。终末期 CKD 的发生率为第 5 年 0.4%，第 10 年 1.6%，第 15 年 2.8%。
HCV 阳性肝硬化患者 CKD 的年发生率约为 1.0-1.5%。此外，终末期 CKD 的年发生率比 CKD 低一个数量级。
