438. The Impact of Chronic Kidney Disease on Hepatic and Extra Hepatic Outcomes among Patients with Hepatitis C Infection
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • arduinoj_192101-0001-IDWeek_Poster-1_v2.00.pdf (351.8 kB)
  • Background: Chronic kidney disease (CKD) is an important co-morbidity among patients with Hepatitis C infection (HCV). There is a paucity of data on the effects of CKD on incidence of hepatic and extra-hepatic outcomes in patients with HCV. We compared anemia, hyperbilirubinemia, End-Stage Liver Disease [ESLD], cryoglobulinemia, hepatocellular carcinoma [HCC], and death between patients with HCV+CKD to those with HCV alone.

    Methods: Patients ≥ 18 years of age seen between 1/1/2004-12/31/2014 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 were >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. Adjusted incidence rates (aIR) and rate ratios (RRs) for the outcomes, comparing the HCV only and HCV+CKD cohorts, were estimated using Poisson models for counts/person-time, adjusting for the following baseline factors: sex, age, race/ethnicity, healthcare utilization, diabetes, cardiovascular, blood disorders, HIV, HBV and CKD stage. Baseline was defined as the year prior to diagnosis date. Observation time began at diagnosis and continued through death, dialysis, transplant, or disenrollment from the KP health plan. Each outcome was modeled separately.

    Results: We identified 16,145 patients with HCV only, and 2,179 patients with HCV+CKD. CKD was associated with a 61% higher death rate (RR=1.61 [95% CI: 1.43-1.81]), a 44% higher rate of ESLD (1.44 [1.17-1.76]), an 85% higher rate of liver transplant recommendation (1.85[1.03-3.32]), more than a 2-fold higher rate of anemia (2.03 [1.80-2.29]), and a 2.58[1.17-5.69] higher rate of cryoglobulinemia. CKD was not associated with increased risk of hyperbilirubinemia or HCC.

    Conclusion: CKD has an independent effect on ESLD, need for liver transplant, anemia, cryoglobulinemia and death among patients with HCV. Future studies are needed to determine whether ‘cure’ from newer direct acting HCV antivirals effect the magnitude of added hepatic/extra-hepatic morbidity among patients with HCV and CKD.

    Carla V. Rodriguez, PhD1, Jean Marie Arduino, PhD2, Jin-Wen Hsu, PhD3, Rong Wei, MA3, Kevin Rubenstein, MS1, Haihong Hu, MS1, Michael Horberg, MD, MAS, FIDSA1, Stephen Derose, MD, MSHS3 and Sara Tartof, PhD, MPH3, (1)Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, (2)Merck & Co Inc, Kenilworth, NJ, (3)Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA

    Disclosures:

    C. V. Rodriguez, None

    J. M. Arduino, Merck: Employee and Shareholder , Salary

    J. W. Hsu, None

    R. Wei, None

    K. Rubenstein, None

    H. Hu, None

    M. Horberg, None

    S. Derose, None

    S. Tartof, None

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