Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwan Residents chronic kidney disease patients acquiring hepatitis B virus infection  

作　　者：Yi-Chun Chen Chung-Yi Li Shiang-Jiun Tsai Yen-Chun Chen 

机构地区：[1]Department of Internal Medicine,Dalin Tzu Chi Hospital,Buddhist Tzu Chi Medical Foundation,Chiayi County 622,Taiwan [2]School of Medicine,Tzu Chi University,Hualien 970,Taiwan [3]Department and Graduate Institute of Public Health,College of Medicine,National Cheng Hung University,Tainan 701,Taiwan [4]Department of Public Health,College of Public Health,China Medical University,Taichung 404,Taiwan [5]Department of Medical Research,Dalin Tzu Chi Hospital,Buddhist Tzu Chi Medical Foundation,Chiayi County 622,Taiwan [6]Division of Hepato-Gastroenterology,Department of Internal Medicine,Dalin Tzu Chi Hospital,Buddhist Tzu Chi Medical Foundation,Chiayi County 622,Taiwan

出　　处：《World Journal of Gastroenterology》2018年第8期917-928,共12页世界胃肠病学杂志（英文版）

基　　金：Supported by Dalin Tzu Chi Hospital,No.DTCRD 104-I-16

摘　　要：AIM 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.METHODS This nationwide cohort study included 103444 Taiwan Residents 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 propensitymatched 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.RESULTS Multivariable Cox regression analysis showed a 1.67-fold higher risk(P < 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(P < 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.CONCLUSION 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.AIM 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.METHODS This nationwide cohort study included 103444 Taiwan Residents 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 propensitymatched 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.RESULTS Multivariable Cox regression analysis showed a 1.67-fold higher risk(P < 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(P < 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.CONCLUSION 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.

关 键 词：hepatitis B virus chronic kidney DISEASE END-STAGE renal DISEASE nucleos(t)ide ANALOGUE cohort study 

分 类 号：R57[医药卫生—消化系统]