Rogal Shari S, Yan Peng, Rimland David, Lo Re Vincent, Al-Rowais Hind, Fried Linda, Butt Adeel A
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA.
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Dig Dis Sci. 2016 Mar;61(3):930-6. doi: 10.1007/s10620-015-3918-z. Epub 2015 Nov 2.
We aimed to assess the incidence and progression of chronic kidney disease (CKD) following hepatitis C virus (HCV) seroconversion.
This retrospective cohort study included Veterans with a confirmed HCV seroconversion between 2001 and 2014 and Veterans with negative HCV testing over the same time period. The outcomes included development of advanced CKD (eGFR < 60 mL/min/1.73 m(2) on two separate occasions at least 90 days apart, plus a ≥ 10 mL/min/1.73 m(2) decline from baseline) and progressive CKD (decline in eGFR of ≥ 30 mL/min/1.73 m(2) from baseline). Multivariable Cox proportional hazards models were used to evaluate the association between HCV and incident advanced and progressive CKD.
The final cohort consisted of 71,528 Veterans, including 2589 with recently seroconverted HCV. Over a mean follow-up of 6 years, 36% of patients with and 31% without HCV developed advanced CKD (p < 0.001), and 35% of patients with vs. 26% without HCV developed progressive CKD (p < 0.001). After controlling for traditional risk factors, recently seroconverted HCV+ patients were significantly less likely to develop advanced CKD (HR 0.86; 95% CI 0.79, 0.92), and HCV status was not significantly associated with progressive CKD (HR 0.93; 95% CI 0.86, 1.00). Factors associated with developing advanced and progressive CKD included older age, female sex, diabetes, hypertension, development of cirrhosis, and substance abuse.
In this cohort of newly infected US Veterans, HCV infection was associated with decreased incidence of advanced and unchanged risk of progressive CKD, suggesting a larger role for traditional risk factors in the development of CKD after HCV seroconversion.
我们旨在评估丙型肝炎病毒（HCV）血清学转换后慢性肾脏病（CKD）的发病率及进展情况。
这项回顾性队列研究纳入了2001年至2014年间确诊HCV血清学转换的退伍军人以及同期HCV检测呈阴性的退伍军人。研究结局包括进展性CKD的发生（估算肾小球滤过率[eGFR]<60 mL/（min·1.73 m²），且在至少间隔90天的两次独立检测中出现，同时较基线水平下降≥10 mL/（min·1.73 m²））以及进展性CKD（eGFR较基线水平下降≥30 mL/（min·1.73 m²））。采用多变量Cox比例风险模型评估HCV与新发进展性和进展性CKD之间的关联。
最终队列由71,528名退伍军人组成，其中包括2589名近期发生HCV血清学转换的患者。在平均6年的随访期内，发生HCV血清学转换的患者中36%以及未发生HCV血清学转换的患者中31%发生了进展性CKD（p<0.001），发生HCV血清学转换的患者中35%以及未发生HCV血清学转换的患者中26%发生了进展性CKD（p<0.001）。在控制了传统危险因素后，近期发生HCV血清学转换的HCV阳性患者发生进展性CKD的可能性显著降低（风险比[HR]0.86；95%置信区间[CI]0.79，0.92），且HCV状态与进展性CKD无显著关联（HR 0.93；95%CI 0.86，1.00）。与发生进展性和进展性CKD相关的因素包括年龄较大、女性、糖尿病、高血压、肝硬化的发生以及药物滥用。
在这群新感染的美国退伍军人中，HCV感染与进展性CKD发病率降低以及进展性CKD风险不变相关联，这表明在HCV血清学转换后CKD的发生中传统危险因素发挥了更大作用。
