Tai-Shuan Lai1,2, Mei-Hsuan Lee3, Hwai-I Yang4, San-Lin You5,6, Sheng-Nan Lu7, Li-Yu Wang8, Yong Yuan9, Gilbert L'Italien9,10, Kuo-Liong Chien2, Chien-Jen Chen2,4. 1. Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan. 2. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. 3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Genomics Research Center, Academia Sinica, Taipei, Taiwan. 5. School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. 6. Big Data Research Center, Fu-Jen Catholic University, New Taipei City, Taiwan. 7. Department of Gastroenterology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan. 8. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. 9. Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ. 10. Yale University School of Medicine, New Haven, CT.
Abstract
The association between hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) remains controversial without considering the role of HCV viral load and genotype. This study aimed to determine whether HCV RNA level and genotype affect the risk of developing ESRD. Between 1991 and 1992, 19,984 participants aged 30-65 years were enrolled in a community-based prospective cohort study in Taiwan. Chronic HCV infection was defined by detectable HCV viral load. ESRD was determined as the need for chronic dialysis or renal transplantation. Conventional Cox proportional hazard and competing risk models were used to determine the hazard ratio (HR) for ESRD. After a median follow-up of 16.8 years, 204 cases were detected during 319,474 person-years. The incidence rates of ESRD for nonchronically HCV-infected and chronically HCV-infected patients were 60.2 and 194.3 per 100,000 person-years, respectively. The multivariable HR was 2.33 (95% confidence interval [CI] 1.40-3.89) when comparing patients with and without chronic HCV infection. Patients with low and high HCV RNA levels were at higher risk of ESRD than those who were nonchronically HCV-infected (HR, 2.11, 95% CI 1.16-3.86, and HR, 3.06, 95% CI 1.23-7.58; Ptrend < 0.001). This association remained robust after taking pre-ESRD death as a competing event for ESRD. Patients with HCV genotype 1 tended to have a higher risk of developing ESRD (HR, 3.60 95% CI 1.83-7.07) compared with nonchronically HCV-infected subjects. CONCLUSIONS: This study reveals that chronic HCV infection is associated with an increased risk of developing ESRD and suggests that elevated serum levels of HCV RNA (>167,000 IU/mL) and HCV genotype 1 are strong predictors of ESRD, indicating clinical implications for the management of chronic HCV. (Hepatology 2017;66:784-793).
The association between hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) remains controversial without considering the role of HCV viral load and genotype. This study aimed to determine whether HCV RNA level and genotype affect the risk of developing ESRD. Between 1991 and 1992, 19,984 participants aged 30-65 years were enrolled in a community-based prospective cohort study in Taiwan. Chronic HCV infection was defined by detectable HCV viral load. ESRD was determined as the need for chronic dialysis or renal transplantation. Conventional Cox proportional hazard and competing risk models were used to determine the hazard ratio (HR) for ESRD. After a median follow-up of 16.8 years, 204 cases were detected during 319,474 person-years. The incidence rates of ESRD for nonchronically HCV-infected and chronically HCV-infectedpatients were 60.2 and 194.3 per 100,000 person-years, respectively. The multivariable HR was 2.33 (95% confidence interval [CI] 1.40-3.89) when comparing patients with and without chronic HCV infection. Patients with low and high HCV RNA levels were at higher risk of ESRD than those who were nonchronically HCV-infected (HR, 2.11, 95% CI 1.16-3.86, and HR, 3.06, 95% CI 1.23-7.58; Ptrend < 0.001). This association remained robust after taking pre-ESRD death as a competing event for ESRD. Patients with HCV genotype 1 tended to have a higher risk of developing ESRD (HR, 3.60 95% CI 1.83-7.07) compared with nonchronically HCV-infected subjects. CONCLUSIONS: This study reveals that chronic HCV infection is associated with an increased risk of developing ESRD and suggests that elevated serum levels of HCV RNA (>167,000 IU/mL) and HCV genotype 1 are strong predictors of ESRD, indicating clinical implications for the management of chronic HCV. (Hepatology 2017;66:784-793).
Authors: Jia Li; Stuart C Gordon; Loralee B Rupp; Talan Zhang; Sheri Trudeau; Scott D Holmberg; Anne C Moorman; Philip R Spradling; Eyasu H Teshale; Joseph A Boscarino; Mark A Schmidt; Yihe G Daida; Mei Lu Journal: Aliment Pharmacol Ther Date: 2019-01-16 Impact factor: 8.171
Authors: Roberto Minutolo; Alessio Aghemo; Antonio Chirianni; Fabrizio Fabrizi; Loreto Gesualdo; Edoardo G Giannini; Paolo Maggi; Vincenzo Montinaro; Ernesto Paoletti; Marcello Persico; Francesco Perticone; Salvatore Petta; Massimo Puoti; Giovanni Raimondo; Maria Rendina; Anna Linda Zignego Journal: Intern Emerg Med Date: 2018-09-25 Impact factor: 3.397