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Digestive Diseases and Sciences

, Volume 60, Issue 12, pp 3801–3813 | Cite as

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

  • Fabrizio Fabrizi
  • Simona Verdesca
  • Piergiorgio Messa
  • Paul Martin
Original Article

Abstract

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.

Keywords

Adult population Chronic kidney disease Hepatitis C Meta-analysis Proteinuria 

Abbreviations

ACEi

Angiotensin-converting enzyme inhibitor

ARB

Angiotensin receptor blocker

aHR

Adjusted hazard ratio

aOR

Adjusted odds ratio

aRR

Adjusted relative risk

CKD

Chronic kidney disease

CCI

Charlson comorbidity index

CIs

Confidence intervals

CV

Cardiovascular

DM

Diabetes mellitus

ESRD

End-stage renal disease

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

ICD

International classification of diseases

GFR

Glomerular filtration rate

IFN

Interferon

I2

Ratio of true heterogeneity to total variation in observed effects

MC

Mixed cryoglobulinemia

MDRD

Modification of diet in renal disease

NA

Not available

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement

Notes

Acknowledgments

This work was supported in part by a “Project Glomerulonephritis” Grant, in memory of Pippo Neglia, by Associazione Amici del Croff-Onlus. The funders had no role in study design, data collection analysis, decision to publish, or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

None.

Supplementary material

10620_2015_3801_MOESM1_ESM.doc (70 kb)
Supplementary material 1 (DOC 70 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Fabrizio Fabrizi
    • 1
    • 2
  • Simona Verdesca
    • 1
  • Piergiorgio Messa
    • 1
  • Paul Martin
    • 2
  1. 1.Division of Nephrology, Maggiore HospitalIRCCS FoundationMilanItaly
  2. 2.Division of HepatologyUniversity School of MedicineMiamiUSA

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