HCV infection and the incidence of CKD
Health Services Needs and Demand
Background: The risk of hepatitis C virus (HCV) infection upon incident chronic kidney disease (CKD) in the presence of traditional risk factors and renal-modifying therapy is not well known. Study Design: National cohort study. Setting & Participants: HCV-infected and -uninfected veterans in ERCHIVES (Electronically Retrieved Cohort of HCV Infected Veterans) in 2001-2006. Predictor: HCV infection. Outcomes: Incident CKD stages 3-5. Results: We identified 18,002 patients with HCV infection and 25,137 controls with estimated glomerular filtration rate >60 mL/min/1.73 m2at baseline. HCV-infected patients had a lower prevalence of several CKD risk factors, including diabetes (22.9% vs 26.6%), hypertension (52.4% vs 60.8%), and dyslipidemia (39.3% vs 73.9%; P < 0.001). HCV infection was associated with a higher risk of developing CKD stages 3-5 (HR, 1.30; 95% CI, 1.23-1.37). Increasing age, hypertension, and diabetes were associated with significantly higher risks of developing CKD in HCV-infected patients and controls. Decompensated liver disease was a strong predictor of CKD in HCV-infected patients (HR, 3.37; 95% CI, 3.10-3.66) and HCV-uninfected controls (HR, 2.04; 95% CI, 1.84-2.25). In Kaplan-Meier analysis, HCV-infected persons had a shorter time to CKD. Limitations: Lack of proteinuria data; small number of women. Conclusions: HCV infection is associated with higher risk and shorter time to CKD despite having a lower prevalence of many CKD risk factors. HCV-infected persons should have targeted monitoring for the development and progression of CKD.