Chen Yi-Chun, Chiou Wen-Yen, Hung Shih-Kai, Su Yu-Chieh, Hwang Shang-Jyh
Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, and School of Medicine, Tzu Chi University, Hualien, Taiwan.
BMC Nephrol. 2013 Sep 6;14:187. doi: 10.1186/1471-2369-14-187.
Hepatitis C virus (HCV) infection and chronic kidney disease (CKD) have high prevalences in Taiwan and worldwide, but the role of HCV infection in causing CKD remains uncertain. This cohort study aimed to explore this association.
This nationwide cohort study examined the association of HCV with CKD by analysis of sampled claims data from Taiwan National Health Insurance Research Database from 1998 to 2004. ICD-9 diagnosis codes were used to identify diseases. We extracted data of 3182 subjects who had newly identified HCV infection and no traditional CKD risk factors and data of randomly selected 12728 matched HCV-uninfected control subjects. Each subject was tracked for 6 years from the index date to identify incident CKD cases. Cox proportional hazard regression was used to determine the risk of CKD in the HCV-infected and control groups.
The mean follow-up durations were 5.88 years and 5.92 years for the HCV-infected and control groups, respectively. Among the sample of 15910 subjects, 251 subjects (1.6%) developed CKD during the 6-year follow-up period, 64 subjects (2.0%) from the HCV-infected group and 187 subjects (1.5%) from the control group. The incidence rate of CKD was significantly higher in the HCV-infected group than in the control group (3.42 vs. 2.48 per 1000 person-years, p = 0.02). Multivariate analysis indicated that the HCV-infected group had significantly greater risk for CKD (adjusted hazard ratio: 1.75, 95% CI: 1.25-2.43, p = 0.0009). This relationship also held for a comparison of HCV-infected and HCV-uninfected subjects who were younger than 70 years and had none of traditional CKD risk factors.
HCV infection is associated with increased risk for CKD beyond the well-known traditional CKD risk factors. HCV patients should be informed of their increased risk for development of CKD and should be more closely monitored.
丙型肝炎病毒（HCV）感染和慢性肾脏病（CKD）在台湾及全球范围内都有很高的患病率，但HCV感染在导致CKD中所起的作用仍不明确。这项队列研究旨在探讨这种关联。
这项全国性队列研究通过分析1998年至2004年台湾全民健康保险研究数据库中的抽样理赔数据，研究HCV与CKD的关联。使用国际疾病分类第九版（ICD - 9）诊断编码来识别疾病。我们提取了3182名新确诊HCV感染且无传统CKD危险因素的受试者的数据，以及随机选取的12728名匹配的未感染HCV对照受试者的数据。从索引日期开始，对每个受试者进行6年的跟踪，以识别CKD发病病例。使用Cox比例风险回归来确定HCV感染组和对照组中CKD的风险。
HCV感染组和对照组的平均随访时间分别为5.88年和5.92年。在15910名受试者的样本中，251名受试者（1.6%）在6年随访期内发生了CKD，其中HCV感染组64名受试者（2.0%），对照组187名受试者（1.5%）。HCV感染组的CKD发病率显著高于对照组（每1000人年3.42例 vs. 2.48例，p = 0.02）。多因素分析表明，HCV感染组发生CKD的风险显著更高（调整后的风险比：1.75，95%置信区间：1.25 - 2.43，p = 0.0009）。对于年龄小于70岁且无传统CKD危险因素的HCV感染组和未感染HCV组受试者的比较，这种关系同样成立。
HCV感染与除了众所周知的传统CKD危险因素之外的CKD风险增加相关。应告知HCV患者其发生CKD的风险增加，并且应对其进行更密切的监测。
