Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1270
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
It is unknown whether adequate hepatitis C virus (HCV) treatment [interferon-based therapy (IBT) or new direct-acting antivirals (DAAs)] improves long-term renal and patient survivals in chronic kidney disease (CKD) patients with HCV infection. Yet, there is a significant value to explore this critical issue.
There is a significant and increasing burden of CKD, end-stage renal disease (ESRD), and HCV infection in Taiwan and worldwide. Taiwan provides an ideal setting for studying this relationship because it has a high prevalence of these three conditions. Because information on DAAs was not available in Taiwan’s single-payer national health insurance database currently released for research, we performed a retrospective analysis of IBT, in CKD patients with HCV infection to increase our understanding of their long-term outcomes following HCV infection and HCV treatment.
To evaluate the long-term outcomes (ESRD and death) of HCV treatment, especially IBT, in HCV-infected patients with stage 1-5 CKD.
By analyzing the Taiwan Longitudinal Health Insurance Database 2005, the authors used propensity score-matched and competing risk analyses to evaluate the long-term effect of HCV infection with and without IBT on the risks of ESRD and death in CKD patients. All participants were followed until the occurrence of ESRD, death, or the end of 2012.
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.
To the best of our knowledge, this is the first study to investigate the long-term renal and patient outcomes in CKD patients with HCV infection and HCV treatment. Adequate HCV treatment in CKD patients improves long-term renal and patient survivals.
Future prospective study is warranted to confirm our findings with new DAAs and better understand the pathological mechanism underlying this association.