Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection

doi:10.3748/wjg.v24.i8.917

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. Feb 28, 2018; 24(8): 917-928
Published online Feb 28, 2018. doi: 10.3748/wjg.v24.i8.917

Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection

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 Hung 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, 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 patients’ 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.

Data sharing statement: No additional data are available.

Correspondence to: Yi-Chun Chen, MD, Assistant Professor, Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin Township, Chiayi County 622, Taiwan. chenyichun0320@yahoo.com.tw

Telephone: +886-5-2648000-5665 Fax: +886-5-2648128

Received: November 4, 2017
Peer-review started: November 4, 2017
First decision: November 22, 2017
Revised: December 10, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: February 28, 2018
Processing time: 114 Days and 21 Hours

Abstract

AIM

To investigate the risk of end-stage renal disease (ESRD) in hepatitis B virus (HBV)-infected patients with chronic kidney disease (CKD) with and without nucleos(t)ide analogue (NA) therapy.

METHODS

This nationwide cohort study included 103444 Taiwanese CKD adults without hepatitis C virus infection from the Taiwan Longitudinal Health Insurance Database 2005 between 1997 and 2012. We identified 2916 CKD patients who acquired HBV infection and did not receive NAs (untreated cohort), and they were propensity-matched 1:4 with 11664 uninfected counterparts. We also identified 442 CKD patients who acquired HBV infection and received NAs (treated cohort), and they were propensity-matched 1:3 with 1326 untreated counterparts. The association between HBV infection, NA use, and ESRD was analyzed using competing risk analysis.

RESULTS

Multivariable Cox regression analysis showed a 1.67-fold higher risk (P < 0.0001) of ESRD in the untreated cohort (16-year cumulative incidence, 10.1%) than in the matched uninfected cohort (16-year cumulative incidence, 6.6%), which was independent of cirrhosis or diabetes. The treated cohort (16-year cumulative incidence, 2.2%) had an 87% lower ESRD risk (P < 0.0001) compared with the matched untreated cohort (16-year cumulative incidence, 11.9%). The number needed to treat for one fewer ESRD after NA use at 12 years was 12. Multivariable stratified analyses verified these associations in all subgroups.

CONCLUSION

This study suggests that untreated HBV infection and NA therapy are associated with increased and decreased risk of ESRD, respectively, in CKD patients. Identification of HBV status and targeted monitoring for ESRD development are important in CKD patients living in HBV-endemic areas.

Keywords: Hepatitis B virus; Chronic kidney disease; End-stage renal disease; Nucleos(t)ide analogue; Cohort study

Core tip: This nationwide retrospective cohort study used propensity score-matched and competing risk analyses to evaluate the effect of untreated hepatitis B virus (HBV) infection and nucleos(t)ide analogue (NA) therapy on the development of end-stage renal disease (ESRD) in chronic kidney disease (CKD) patients who acquired HBV infection. We found that untreated HBV infection in CKD patients was associated with an increased risk of ESRD, while NA therapy reduced the risk.