Published online Feb 28, 2018. doi: 10.3748/wjg.v24.i8.917
Peer-review started: November 4, 2017
First decision: November 22, 2017
Revised: December 10, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: February 28, 2018
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.
This nationwide cohort study included 103444 Taiwanese 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 propensity-matched 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.
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.
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.
Core tip: This nationwide retrospective cohort study used propensity score-matched and competing risk analyses to evaluate the effect of untreated hepatitis B virus (HBV) infection and nucleos(t)ide analogue (NA) therapy on the development of end-stage renal disease (ESRD) in chronic kidney disease (CKD) patients who acquired HBV infection. We found that untreated HBV infection in CKD patients was associated with an increased risk of ESRD, while NA therapy reduced the risk.