Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Processing time: 94 Days and 15.7 Hours
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
To evaluate the long-term outcomes (ESRD and death) of HCV treatment, especially IBT, in HCV-infected patients with stage 1-5 CKD.
Research methods
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.
Research 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.
Research conclusions
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.
Research perspectives
Future prospective study is warranted to confirm our findings with new DAAs and better understand the pathological mechanism underlying this association.
