434. The Impact of Untreated Hepatitis C Infection on Progression of Renal Decline among Patients with Chronic Kidney Disease
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • arduinoj_192102-0001_IDWeek_poster-2_v2.00.pdf (274.4 kB)
  • Background: Whether untreated hepatitis C virus infection (HCV) accelerates the progression of renal decline and development of end-stage renal disease (ESRD) among patients with chronic kidney disease (CKD) is poorly understood.

    Methods: Patients ≥ 18 years of age with incident HCV and CKD diagnoses from 1/1/2004 to 12/31/2014 from Kaiser Permanente in Southern California and Mid-Atlantic States were included. CKD was identified by 2 occasions of eGFR < 60 mL/min/1.73m2 that are >90 days apart, with eGFR never returning ≥60. Chronic HCV infection was identified by at least one of: positive HCV RNA, HCV genotype, ≥2 refills of anti-HCV drugs within 1 year, and positive HCV antibody test plus ≥1 HCV-coded visit. Baseline was defined as the year prior to index date (date of CKD or HCV diagnosis, the latter for the CKD+HCV cohort). We compared the rate of change in the estimated glomerular filtration rate (eGFR), time to a 25% decrease in eGFR, and time to ESRD between HCV treatment-naive patients with CKD compared to those with CKD alone. We used generalized estimating equations adjusted for age, sex, race/ethnicity, baseline eGFR, type I and II diabetes, hypertension, acute myocardial infarction, HIV, HBV, and CKD stage to compare the rate of change in eGFR between the CKD only and CKD+HCV groups. Time to a 25% decrease in eGFR and time to ESRD were estimated using Cox Proportional Hazards models adjusted for covariates as above, censoring at death, dialysis, transplant, or KP plan disenrollment. The ESRD model was censored on death and disenrollment.

    Results: We identified 150,712 patients with CKD only, and 1706 patients with HCV+CKD. In the adjusted GEE model, eGFR declined by 1.24 (95% CI: -1.88 to -0.61) points more per year in those with HCV and CKD compared with those with CKD alone. The hazards of a 25% decline in eGFR was 1.54 (95% CI: 1.42 to 1.67) times higher; and hazards of ESRD were 2.53 (95% CI: 2.13 to 3.01) times higher in those with HCV+CKD, compared to those with CKD alone.

    Conclusion: Untreated HCV has a substantial independent effect on renal decline among patients with CKD. It remains to be seen whether the use of newer direct acting HCV antivirals can mitigate the magnitude and rate of renal decline and progression to ESRD among patients with HCV and CKD.

    Sara Tartof, PhD, MPH1, Jean Marie Arduino, PhD2, Rong Wei, MA1, Jin-Wen Hsu, PhD1, Kevin Rubenstein, MS3, Haihong Hu, MS3, Michael Horberg, MD, MAS, FIDSA3, Stephen Derose, MD, MSHS1 and Carla Rodriguez, PhD4, (1)Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, (2)Merck & Co Inc, Kenilworth, NJ, (3)Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, (4)Kaiser Permanente Mid-Atlantic States, Rockville, MD

    Disclosures:

    S. Tartof, None

    J. M. Arduino, None

    R. Wei, None

    J. W. Hsu, None

    K. Rubenstein, None

    H. Hu, None

    M. Horberg, None

    S. Derose, None

    C. Rodriguez, None

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