Hepatitis C Virus Infection Increases the Risk of Developing Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background and Rationale Chronic kidney disease and hepatitis C virus are prevalent in the general population worldwide, and controversy exists about the impact of HCV infection on the development and progression of kidney disease.Design A systematic review of the published medical literature was made to assess whether positive anti-HCV serologic status plays an independent impact on the development of chronic kidney disease in the adult general population. We used a random-effects model to generate a summary estimate of the relative risk of chronic kidney disease (defined by reduced glomerular filtration rate or detectable proteinuria) with HCV across the published studies. Meta-regression and stratified analysis were also conducted.Results Twenty-three studies (n = 2,842,421 patients) were eligible, and separate meta-analyses were performed according to the outcome. Pooling results of longitudinal studies (n = 9; 1,947,034 unique patients) demonstrated a relationship between positive HCV serologic status and increased incidence of chronic kidney disease, the summary estimate for adjusted hazard ratio was 1.43 (95 % confidence interval 1.23; 1.63, P = 0.0001), and between-studies heterogeneity was noted (P value by Q test < 0.0001). The risk of the incidence of chronic kidney disease associated with HCV, in the subset of Asian surveys, was 1.31 (95 % confidence interval 1.16; 1.45) without heterogeneity (P value by Q test = 0.6). HCV positive serology was an independent risk factor for proteinuria; adjusted odds ratio, 1.508 (95 % confidence intervals 1.19; 1.89, P = 0.0001) (n = 6 studies; 107,356 unique patients).Conclusions HCV infection is associated with an increased risk of developing chronic kidney disease in the adult general population.

背景与理论依据 慢性肾脏病和丙型肝炎病毒在全球普通人群中普遍存在，关于丙型肝炎病毒（HCV）感染对肾脏病发生和进展的影响存在争议。 设计 对已发表的医学文献进行系统综述，以评估抗 - HCV血清学阳性状态是否对成年普通人群慢性肾脏病的发生有独立影响。我们使用随机效应模型对已发表研究中HCV与慢性肾脏病（通过肾小球滤过率降低或可检测到的蛋白尿定义）的相对风险进行汇总估计。还进行了元回归和分层分析。 结果 有23项研究（n = 2842421例患者）符合条件，并根据结果分别进行了荟萃分析。纵向研究（n = 9；1947034例独立患者）的汇总结果表明，HCV血清学阳性状态与慢性肾脏病发病率增加之间存在关联，调整后的风险比汇总估计值为1.43（95%置信区间1.23；1.63，P = 0.0001），且研究间存在异质性（Q检验P值<0.0001）。在亚洲调查的亚组中，与HCV相关的慢性肾脏病发病风险为1.31（95%置信区间1.16；1.45），无异质性（Q检验P值 = 0.6）。HCV血清学阳性是蛋白尿的独立危险因素；调整后的比值比为1.508（95%置信区间1.19；1.89，P = 0.0001）（n = 6项研究；107356例独立患者）。 结论 在成年普通人群中，HCV感染与慢性肾脏病发生风险增加有关。