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HCV Increases Mortality Among Patients with CKD

Veterans with chronic kidney disease and hepatitis C virus infection were found to have an increased rate of mortality, risk of lower kidney function and incidence of loss of kidney function vs. veterans without the infection, according to new study data.

“Hepatitis C affects 4 million Americans [and] previous studies have not established unanimously whether hepatitis C is associated with the development and progression of chronic kidney disease,” Csaba P. Kovesdy, MD, director of the Clinical Outcomes and Clinical Trials Program at Memphis VA Medical Center in Tenn., told Healio.com/Hepatology. “[The study] examined the association of hepatitis C infection with mortality, with the development of new onset chronic kidney disease, with end stage renal disease and with the speed of loss of kidney function in over 1 million U.S. veterans. We found that hepatitis C infection was associated with a significantly increased risk of all these end points.”

Csaba P. Kovesdy

Kovesdy and colleagues analyzed data from 100,518 veterans with chronic kidney disease (CKD) positive for HCV and 920,531 US veterans without HCV with normal baseline estimated glomerular filtration rate (eGFR). The incidence of decreased kidney function was defined as an eGFR < 60 mL/min/1.73 m and a 25% decrease in eGFR.

Using multivariable adjusted models, the researchers found that HCV was associated with a 2.2-fold higher mortality (fully adjusted HR = 2.17; 95% CI, 2.13-2.21), a 15% higher incident rate of decreased kidney function (adjust HR = 1.15; 95% CI, 1.12-1.17), a 22% higher risk of steeper slopes of eGFR (adjusted OR = 1.22; 95% CI, 1.19-1.26) and a 98% higher hazard of end-stage renal disease (ESRD; adjusted HR = 1.98; 95% CI, 1.81-2.16), according to the research.

“The strongest association was with higher mortality and ESRD,” Kovesdy said.

In a competing-risk regression analysis, HCV-positive status was also found to be associated with an increased risk of new-onset eGFR < 60 mL/min/1.73 m and an increased risk of ESRD. Viremic patients also had a 10% higher risk for new-onset eGFR < 60 mL/min/1.73 m (HR = 1.1; 95% CI, 1.05-1.16), 62% higher risk for ESRD (HR = 1.62; 95% CI, 1.26-2.07) and a 23% higher risk for deterioration of kidney function (HR = 1.23; 95% CI, 1.14-1.33) compared with patients who were negative for HCV antibody.

“Our results suggest that treatment of hepatitis C may be beneficial in lowering mortality and both in preventing the development of new onset CKD and the progression of established CKD,” Kovesdy said. “The emergence of new therapeutic agents for hepatitis C now offer the potential to treat hepatitis C even in patients with CKD, which makes the results concerning progression of CKD especially interesting. These hypotheses will need to be tested in clinical trials.” – by Melinda Stevens

Disclosures: Molnar and Kovesdy report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.