Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2019; 7(11): 1270-1281
Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1270
Anti-hepatitis C virus therapy in chronic kidney disease patients improves long-term renal and patient survivals
Yi-Chun Chen, Chung-Yi Li, Shiang-Jiun Tsai, Yen-Chun Chen
Yi-Chun Chen, Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
Yi-Chun Chen, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
Chung-Yi Li, Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
Chung-Yi Li, Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
Shiang-Jiun Tsai, Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
Yen-Chun Chen, Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
Author contributions: Chen YC designed the research; Chen YC, Li CY, and Tsai SJ performed the research; Chen YC, Li CY, Tsai SJ, and Chen YC analyzed the data; Chen YC wrote the paper; Li CY, Tsai SJ, and Chen YC critically revised the manuscript for important intellectual content.
Supported by Dalin Tzu Chi Hospital, No. DTCRD 104-I-16.
Institutional review board statement: This study was approved by the institutional review board of the Dalin Tzu Chi Hospital (B10302011).
Informed consent statement: All patient information was de-identified in the database (LHID2005) and no informed consent was required. This study was exempt from a full ethical review by the institutional review board of the Dalin Tzu Chi Hospital (B10302011).
Conflict-of-interest statement: All authors have no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Chun Chen, MD, Assistant Professor, Doctor, Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan. chenyichun0320@yahoo.com.tw
Telephone: +886-5-2648000-5665 Fax: +886-5-2648128
Received: March 4, 2019
Peer-review started: March 4, 2019
First decision: March 27, 2019
Revised: April 14, 2019
Accepted: April 18, 2019
Article in press: April 19, 2019
Published online: June 6, 2019
Abstract
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 single-payer 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 Taiwanese 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 = 0.001) were greatest in HCV-infected CKD patients who received at least 4 mo of IBT, which accounted for 74% of the treated cohort.

CONCLUSION

Adequate anti-HCV therapy in CKD patients improves long-term renal and patient survival.

Keywords: Hepatitis C virus, Chronic kidney disease, End-stage renal disease, Anti-hepatitis C virus therapy, Cohort study

Core tip: This large nationwide retrospective cohort study used propensity score-matched and competing risk analyses to evaluate the long-term hard endpoints of hepatitis C virus (HCV) infection and anti-HCV therapy, especially interferon-based therapy, in chronic kidney disease patients. We found that untreated HCV infection in chronic kidney disease was associated with increased risks of end-stage renal disease and mortality. On the contrary, adequate anti-HCV therapy in chronic kidney disease patients improves long-term renal and patient survival.