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Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection.
World J Gastroenterol 2018; 24(8):917-928WJ

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.

Authors+Show Affiliations

Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan.Department and Graduate Institute of Public Health, College of Medicine, National Cheng Hung University, Tainan 701, Taiwan.Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan。 chenyichun0320@yahoo.com.tw.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29491685

Citation

Chen, Yi-Chun, et al. "Nationwide Cohort Study Suggests That Nucleos(t)ide Analogue Therapy Decreases Dialysis Risk in Taiwanese Chronic Kidney Disease Patients Acquiring Hepatitis B Virus Infection." World Journal of Gastroenterology, vol. 24, no. 8, 2018, pp. 917-928.
Chen YC, Li CY, Tsai SJ, et al. Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection. World J Gastroenterol. 2018;24(8):917-928.
Chen, Y. C., Li, C. Y., Tsai, S. J., & Chen, Y. C. (2018). Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection. World Journal of Gastroenterology, 24(8), pp. 917-928. doi:10.3748/wjg.v24.i8.917.
Chen YC, et al. Nationwide Cohort Study Suggests That Nucleos(t)ide Analogue Therapy Decreases Dialysis Risk in Taiwanese Chronic Kidney Disease Patients Acquiring Hepatitis B Virus Infection. World J Gastroenterol. 2018 Feb 28;24(8):917-928. PubMed PMID: 29491685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nationwide cohort study suggests that nucleos(t)ide analogue therapy decreases dialysis risk in Taiwanese chronic kidney disease patients acquiring hepatitis B virus infection. AU - Chen,Yi-Chun, AU - Li,Chung-Yi, AU - Tsai,Shiang-Jiun, AU - Chen,Yen-Chun, PY - 2017/11/04/received PY - 2017/12/10/revised PY - 2017/12/20/accepted PY - 2018/3/2/entrez PY - 2018/3/2/pubmed PY - 2018/9/12/medline KW - Chronic kidney disease KW - Cohort study KW - End-stage renal disease KW - Hepatitis B virus KW - Nucleos(t)ide analogue SP - 917 EP - 928 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 24 IS - 8 N2 - 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. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/29491685/Nationwide_cohort_study_suggests_that_nucleos_t_ide_analogue_therapy_decreases_dialysis_risk_in_Taiwanese_chronic_kidney_disease_patients_acquiring_hepatitis_B_virus_infection_ L2 - http://www.wjgnet.com/1007-9327/full/v24/i8/917.htm DB - PRIME DP - Unbound Medicine ER -