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SVR Reduces Kidney Disease Risks/ HCV Causes Increased Kidney Disease Risks
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new study below -"chronic HCV infection resulted in a 2.2-fold increased risk of ESRD -end stage renal disease] .....participants with low and those with high HCV RNA levels had a 2.1-fold and 3.1-fold increased risks of developing ESRD, respectively. Patients with HCV genotype 1 had a higher risk of developing ESRD"
AASLD/2016: The Impact of Hepatitis C Viral Cure on Progression of Renal Disease - (11/14/16)
EASL: The cumulative prevalence and incidence of extra-hepatic manifestations in patients with hepatitis C virus infection: real-world evidence from the United States - (05/03/17)
CROI/2016: Hepatitis C and the Risk of Non-Liver-Related Morbidity and Mortality in HIV+ Persons....kidney, bone, cardiovascular - (04/4/16)
Chronic Hepatitis C Virus Infection and Cancer Risks: A Population-Based Cohort Study - (11/14/16)
EASL: Extra-hepatic manifestations from hepatitis C virus infection related to female infertility and adverse pregnancy outcomes: A real-world observation - (05/03/17)
Eradication of HCV and non-liver-related non-AIDS-related events (CVD/diabetes/kidney/cancers) in HIV/HCV coinfection - (02/01/17) - After a median five-year follow-up, SVR was found to be associated with a significant decrease in the hazard of diabetes mellitus (sHR 0.57 [95% CI, 0.35 - 0.93] P= .024) and decline in the hazard of chronic renal failure close to the threshold of significance (sHR 0.43 [95% CI, 0.17 - 1.09], P=.075).
CROI/2016: Understanding the Relative Contributions of IDU and HCV on Systemic Immune Activation HCV should be aggressively treated in current IDUs even more if HIV and/or HCV positive - (04/4/16) HCV treatment should be aggressive in IDUs because their immune system is activated, immune activation can lead to inflammation which can have poor long-term outcomes, we know that the onset of & early & accelerated & premature onset of comorbidities like heart disease, neurologic impairment, and perhaps kidney disease, bone disease & frailty are all associated with immune activation & to inflammation
EASL: Prognostic value of viral eradication for major adverse cardiovascular events in hepatitis C cirrhotic patients. ANRS CO12 CirVir Cohort - (04/26/17)
EASL: THERAPY WITH DIRECT ANTIVIRAL AGENTS IN PATIENTS WITH HCV-RELATED LYMPHOPROLIFERATIVE DISORDERS AND MIXED CRYOGLOBULINEMIA - (04/26/17)
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Hepatitis C viral load, genotype, and increased risk of developing end-stage renal disease: REVEAL-HCV study
Hepatology July 2017
"Our study demonstrated that chronic HCV infection is an independent risk factor for the development of ESRD. During more than 15 years of follow-up, chronic HCV infection resulted in a 2.2-fold increased risk of ESRD after taking pre-ESRD death as a competing risk. Compared with participants who were not chronically HCV-infected, participants with low and those with high HCV RNA levels had a 2.1-fold and 3.1-fold increased risks of developing ESRD, respectively. Patients with HCV genotype 1 had a higher risk of developing ESRD......this study is a reminder that the risk of ESRD among patients with chronic HCV infection may be underrecognized, especially among those with elevated serum levels of HCV RNA (>167,000 IU/mL) and HCV genotype 1. All patients with chronic HCV infection should undergo a thorough renal survey at diagnosis and receive regular follow-up.”
Abstract
The association between hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) remains controversial without considering the role of HCV viral load and genotype. This study aimed to determine whether HCV RNA level and genotype affect the risk of developing ESRD. Between 1991 and 1992, 19,984 participants aged 30-65 years were enrolled in a community-based prospective cohort study in Taiwan. Chronic HCV infection was defined by detectable HCV viral load. ESRD was determined as the need for chronic dialysis or renal transplantation. Conventional Cox proportional hazard and competing risk models were used to determine the hazard ratio (HR) for ESRD. After a median follow-up of 16.8 years, 204 cases were detected during 319,474 person-years. The incidence rates of ESRD for nonchronically HCV-infected and chronically HCV-infected patients were 60.2 and 194.3 per 100,000 person-years, respectively. The multivariable HR was 2.33 (95% confidence interval [CI] 1.40-3.89) when comparing patients with and without chronic HCV infection. Patients with low and high HCV RNA levels were at higher risk of ESRD than those who were nonchronically HCV-infected (HR, 2.11, 95% CI 1.16-3.86, and HR, 3.06, 95% CI 1.23-7.58; Ptrend < 0.001). This association remained robust after taking pre-ESRD death as a competing event for ESRD. Patients with HCV genotype 1 tended to have a higher risk of developing ESRD (HR, 3.60 95% CI 1.83-7.07) compared with nonchronically HCV-infected subjects. Conclusions: This study reveals that chronic HCV infection is associated with an increased risk of developing ESRD and suggests that elevated serum levels of HCV RNA (>167,000 IU/mL) and HCV genotype 1 are strong predictors of ESRD, indicating clinical implications for the management of chronic HCV.
Introduction
Chronic kidney disease (CKD) and resultant end-stage renal disease (ESRD) represent a global health challenge that is associated with high medical costs and poor treatment outcomes.[1] Conventional risk factors for CKD include age, male gender, a history of smoking, diabetes, and hypertension; however, these risk factors cannot fully explain the occurrence of the disease, and new risk factors and markers have been identified.[2] The role of chronic infectious disease, which is a new risk factor, may be underestimated. Previous research has documented an association between hepatitis C virus (HCV) infection and glomerulonephritis.[3] However, our understanding of the relationship between HCV infection and ESRD remains limited.
More than 110 million people worldwide have chronic HCV infection, and around 80 million people are HCV viremic.[4] Chronic liver disease is common in patients with HCV, but 40%-74% of patients develop at least one extrahepatic manifestation.[5] HCV is associated with various glomerular diseases, particularly membranous proliferative glomerulonephritis in the context of cryoglobulinemia. The majority of cryoglobulinemic HCV-infected patients have either no or negligible clinical manifestations.[6] In observational studies, the prevalence of HCV infection is much higher in patients undergoing dialysis or in those who are new to dialysis than in normal volunteers.[7, 8] Cross-sectional and retrospective studies have explored the relationship between HCV infection, proteinuria, and low glomerular filtration rate (GFR), but the results have been conflicting.[9-15] In 2007, a US veterans retrospective study demonstrated that HCV seropositivity was associated with a greater than 2-fold risk of developing ESRD; however, the HCV diagnosis was based on a positive HCV antibody test, as in most previous studies. The impacts of the HCV viral load, which represents the degree of active infection, and that of HCV genotypes, which influences the response to antiviral therapy, on the risk of ESRD remain to be clarified.
Taiwan is known to be an HCV-endemic area and shares one of the highest prevalence rates of ESRD worldwide.[16] Unlike HCV-infected patients in other countries who are at risk of drug injections, human immunodeficiency virus (HIV) coinfection, or HCV-contaminated vaccinations,[17, 18] the major risk factors of HCV infection in Taiwan are iatrogenic.[19] The Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer (REVEAL)-HCV study, a large prospective community-based cohort study in Taiwan, provides an excellent opportunity to investigate the natural history of chronic hepatitis C and long-term diseases associated with it.[20] This study aimed to assess the risk of developing ESRD in relation to HCV serostatus, HCV RNA level, and HCV genotypes. Accordingly, we conducted a large-scale community-based cohort study to determine whether chronic HCV infection is an independent risk factor for ESRD.
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