Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.
Department of Medicine, University of Florida, Gainesville, FL.
Hepatology. 2018 Feb;67(2):492-504. doi: 10.1002/hep.29505. Epub 2017 Dec 23.
We assessed the risk of chronic kidney disease (CKD) in chronic hepatitis C virus (HCV)-infected patients and the incidence reduction of CKD after receipt of HCV treatment. We also evaluated the risk of membranoproliferative glomerulonephritis (MPGN) and cryoglobulinemia in chronic HCV patients. A retrospective cohort analysis of the Truven Health MarketScan Database (2008-2015) in the United States was conducted. In a cohort of 56,448 HCV-infected patients and 169,344 propensity score (1:3)-matched non-HCV patients, we examined the association of HCV infection with the incidence of CKD. Of 55,818 HCV patients, 6.6 % (n = 3666), 6.3% (n = 3534), and 8.3% (n = 4628) patients received either interferon-based dual, triple, or all-oral direct acting antiviral agent therapy, respectively, whereas 79% of patients did not receive any HCV treatment. Cox proportional hazards models were used to compare the risk of developing CKD in HCV patients compared with non-HCV patients and treated patients compared with untreated HCV patients. In a multivariate time-varying Cox regression model, HCV-infected patients had a 27% increased risk of CKD compared with non-HCV patients (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.18-1.37). Among HCV patients, individuals who received the minimally effective HCV treatment for dual, triple, or all-oral therapy had a 30% decreased risk of developing CKD (HR, 0.70; 95% CI, 0.55-0.88). In addition, HCV-infected patients experienced a twofold and a nearly 17-fold higher risk of MPGN (HR, 2.23; 95% CI, 1.84-2.71) and cryoglobulinemia (HR, 16.91; 95% CI, 12.00-23.81) respectively, compared with non-HCV patients. Conclusion: HCV-infected individuals in the United States are at greater risk of developing CKD, MPGN, and cryoglobulinemia. Minimally effective treatment of HCV infection can prevent the development of CKD, although the association was not significant for all-oral therapy. (Hepatology 2018;67:492-504).
我们评估了慢性丙型肝炎病毒（HCV）感染患者发生慢性肾脏病（CKD）的风险，以及接受 HCV 治疗后 CKD 发病率的降低情况。我们还评估了慢性 HCV 患者发生膜增生性肾小球肾炎（MPGN）和冷球蛋白血症的风险。本研究在美国 Truven Health MarketScan 数据库（2008-2015 年）中进行了回顾性队列分析。在 HCV 感染患者的 56448 例队列和 169344 例倾向评分（1:3）匹配的非 HCV 患者队列中，我们检测了 HCV 感染与 CKD 发病的相关性。在 55818 例 HCV 患者中，分别有 6.6%（n=3666）、6.3%（n=3534）和 8.3%（n=4628）的患者接受了干扰素为基础的双联、三联或全口服直接作用抗病毒药物治疗，而 79%的患者未接受任何 HCV 治疗。Cox 比例风险模型用于比较 HCV 患者与非 HCV 患者、治疗患者与未治疗 HCV 患者发生 CKD 的风险。在多变量时变 Cox 回归模型中，与非 HCV 患者相比，HCV 感染患者发生 CKD 的风险增加 27%（风险比[HR]，1.27；95%置信区间[CI]，1.18-1.37）。在 HCV 患者中，接受双联、三联或全口服治疗的最低有效 HCV 治疗的个体发生 CKD 的风险降低 30%（HR，0.70；95%CI，0.55-0.88）。此外，与非 HCV 患者相比，HCV 感染患者发生 MPGN（HR，2.23；95%CI，1.84-2.71）和冷球蛋白血症（HR，16.91；95%CI，12.00-23.81）的风险分别增加了两倍和近 17 倍。结论：美国 HCV 感染个体发生 CKD、MPGN 和冷球蛋白血症的风险增加。最低有效 HCV 感染治疗可以预防 CKD 的发生，尽管全口服治疗的相关性不显著。（Hepatology 2018;67:492-504）。
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