Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan.
Department and Graduate Institute of Public Health, College of Medicine, National Cheng Hung University, Tainan 701, Taiwan.
World J Gastroenterol. 2018 Feb 28;24(8):917-928. doi: 10.3748/wjg.v24.i8.917.
To investigate the risk of end-stage renal disease (ESRD) in hepatitis B virus (HBV)-infected patients with chronic kidney disease (CKD) with and without nucleos(t)ide analogue (NA) therapy.
This nationwide cohort study included 103444 Taiwanese CKD adults without hepatitis C virus infection from the Taiwan Longitudinal Health Insurance Database 2005 between 1997 and 2012. We identified 2916 CKD patients who acquired HBV infection and did not receive NAs (untreated cohort), and they were propensity-matched 1:4 with 11664 uninfected counterparts. We also identified 442 CKD patients who acquired HBV infection and received NAs (treated cohort), and they were propensity-matched 1:3 with 1326 untreated counterparts. The association between HBV infection, NA use, and ESRD was analyzed using competing risk analysis.
Multivariable Cox regression analysis showed a 1.67-fold higher risk ( < 0.0001) of ESRD in the untreated cohort (16-year cumulative incidence, 10.1%) than in the matched uninfected cohort (16-year cumulative incidence, 6.6%), which was independent of cirrhosis or diabetes. The treated cohort (16-year cumulative incidence, 2.2%) had an 87% lower ESRD risk ( < 0.0001) compared with the matched untreated cohort (16-year cumulative incidence, 11.9%). The number needed to treat for one fewer ESRD after NA use at 12 years was 12. Multivariable stratified analyses verified these associations in all subgroups.
This study suggests that untreated HBV infection and NA therapy are associated with increased and decreased risk of ESRD, respectively, in CKD patients. Identification of HBV status and targeted monitoring for ESRD development are important in CKD patients living in HBV-endemic areas.
研究慢性肾脏病（CKD）合并或不合并核苷（酸）类似物（NA）治疗的乙型肝炎病毒（HBV）感染患者发生终末期肾病（ESRD）的风险。
本项全国性队列研究纳入了 1997 年至 2012 年期间来自台湾健保数据库的 103444 名无丙型肝炎病毒感染的台湾成年 CKD 患者，共识别出 2916 例未接受 NAs 治疗的（未治疗组）HBV 感染 CKD 患者和 11664 例无感染对照者（1:4 倾向评分匹配），也识别出 442 例接受 NAs 治疗的（治疗组）HBV 感染 CKD 患者和 1326 例未治疗对照者（1:3 倾向评分匹配）。使用竞争风险分析评估 HBV 感染、NA 使用与 ESRD 之间的关联。
多变量 Cox 回归分析显示，未治疗组（16 年累积发生率为 10.1%）的 ESRD 风险比（HR）为 1.67 倍（<0.0001），高于匹配的无感染对照组（16 年累积发生率为 6.6%），这与肝硬化或糖尿病无关。治疗组（16 年累积发生率为 2.2%）的 ESRD 风险比未治疗组低 87%（<0.0001），12 年后，NA 治疗每减少一例 ESRD 的治疗人数需要 12 人。多变量分层分析在所有亚组中均验证了这些关联。
本研究表明，HBV 未治疗感染和 NA 治疗分别与 CKD 患者 ESRD 风险增加和降低相关。在 HBV 流行地区，识别 HBV 状态并针对性监测 ESRD 发生对 CKD 患者很重要。
