Anti-hepatitis C virus therapy in chronic kidney disease patients improves long-term renal and patient survivals  

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

机构地区：[1]Division of Nephrology, 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 Kung 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 Clinical Cases》2019年第11期1270-1281,共12页世界临床病例杂志

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

摘　　要：BACKGROUND Hepatitis C virus (HCV) infection is a documented risk factor for chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, to date there are no reports on the long-term hard endpoints (ESRD and death) of anti-HCV therapy [interferon-based therapy (IBT) or new direct-acting antivirals] in CKD patients. Direct-acting antivirals are not available in Taiwan’s singlepayer national health insurance database currently released for research. Therefore, we hypothesized that a retrospective analysis of the long-term outcomes of IBT in CKD patients will serve as a proxy for direct-acting antivirals to increase our understanding of progression to ESRD following HCV infection. AIM To evaluate the long-term outcomes (ESRD and death) of anti-HCV therapy, especially IBT, in HCV-infected patients with stage 1-5 CKD. METHODS We analyzed 93894 Taiwan Residents adults diagnosed with CKD and without HBV infection. Of these, 4.9% were infected with HCV. Of the 4582 HCV-infected CKD patients, 482 (10.5%) received IBT (treated cohort). They were matched 1:4 with 1928 untreated HCV-infected CKD patients (untreated cohort) by propensity scores and year, which further matched 1:2 by propensity scores with 3856 CKD patients without HCV infection (uninfected cohort). All participants were followed until the occurrence of ESRD, death, or the end of 2012. The association between HCV infection, IBT use, and risks of ESRD and death was analyzed using competing risk analysis. RESULTS Taking the uninfected cohort as a reference, the adjusted hazard ratios for ESRD, after adjusting for competing mortality, were 0.34 (0.14-0.84, P = 0.019) and 1.28 (1.03-1.60, P = 0.029) in the treated and untreated cohorts, respectively. The treated cohort had a 29%(0.54-0.92, P = 0.011) decrease in mortality compared to the untreated cohort, in which the mortality was 31%(1.18-1.45, P < 0.001) higher than in the uninfected cohort. The reduced risks of ESRD (0.14, 0.03–0.58, P = 0.007) and death (0.57, 0.41-0.79, P = 0BACKGROUND Hepatitis C virus(HCV) infection is a documented risk factor for chronic kidney disease(CKD) and progression to end-stage renal disease(ESRD). However, to date there are no reports on the long-term hard endpoints(ESRD and death) of anti-HCV therapy [interferon-based therapy(IBT) or new direct-acting antivirals]in CKD patients. Direct-acting antivirals are not available in Taiwan’s singlepayer national health insurance database currently released for research.Therefore, we hypothesized that a retrospective analysis of the long-term outcomes of IBT in CKD patients will serve as a proxy for direct-acting antivirals to increase our understanding of progression to ESRD following HCV infection.AIM To evaluate the long-term outcomes(ESRD and death) of anti-HCV therapy,especially IBT, in HCV-infected patients with stage 1-5 CKD.METHODS We analyzed 93894 Taiwan Residents adults diagnosed with CKD and without HBV infection. Of these, 4.9% were infected with HCV. Of the 4582 HCV-infected CKD patients, 482(10.5%) received IBT(treated cohort). They were matched 1:4 with1928 untreated HCV-infected CKD patients(untreated cohort) by propensity scores and year, which further matched 1:2 by propensity scores with 3856 CKD patients without HCV infection(uninfected cohort). All participants were followed until the occurrence of ESRD, death, or the end of 2012. The association between HCV infection, IBT use, and risks of ESRD and death was analyzed using competing risk analysis.RESULTS Taking the uninfected cohort as a reference, the adjusted hazard ratios for ESRD,after adjusting for competing mortality, were 0.34(0.14-0.84, P = 0.019) and 1.28(1.03-1.60, P = 0.029) in the treated and untreated cohorts, respectively. The treated cohort had a 29%(0.54-0.92, P = 0.011) decrease in mortality compared to the untreated cohort, in which the mortality was 31%(1.18-1.45, P < 0.001) higher than in the uninfected cohort. The reduced risks of ESRD(0.14, 0.03–0.58, P =0.007) and death(0.57, 0.41-0.79, P = 0.001) were greatest in

关 键 词：Hepatitis C VIRUS Chronic kidney DISEASE END-STAGE RENAL DISEASE ANTIHEPATITIS C VIRUS THERAPY Cohort study 

分 类 号：R[医药卫生]