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Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults.
BMC Med 2018; 16(1):93BM

Abstract

BACKGROUND

Existing evidence remains inconclusive as to the association between chronic hepatitis B virus (HBV) infection and the risk of chronic kidney disease (CKD). We prospectively examined the association between chronic HBV infection and CKD risk, and the joint associations of HBV infection with established risk factors of several lifestyle factors and prevalent diseases on CKD risk.

METHODS

Participants from the China Kadoorie Biobank were enrolled during 2004-2008 and followed up until 31 December 2015. After excluding participants with previously diagnosed CKD, cancer, heart disease, and stroke at baseline, the present study included 469,459 participants. Hepatitis B surface antigen (HBsAg) was qualitatively tested at baseline. Incident CKD cases were identified mainly through the health insurance system and disease and death registries.

RESULTS

During a median follow-up of 9.1 years (4.2 million person-years), we documented 4555 incident cases of CKD. Cox regression yielded multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with HBsAg-negative participants, the multivariable-adjusted HR (95% CI) for CKD was 1.37 (1.18, 1.60) for HBsAg-positive participants. The association was stronger in men (HR = 1.77; 95% CI: 1.43, 2.20) than in women (HR = 1.10; 95% CI: 0.88, 1.36). HBsAg-positive participants, with or without hepatitis or cirrhosis, whether or not under treatment, all showed increased risk of developing CKD. We observed positive additive interactions of HBsAg positivity with smoking, physical inactivity, or diabetes on CKD risk. Compared with HBsAg-negative participants who were nonsmokers, more physically active, or did not have diabetes at baseline, the greatest CKD risk for HBsAg-positive participants was for those who were smokers (HR = 1.85; 95% CI: 1.44, 2.38), physically inactive (HR = 1.91; 95% CI: 1.52, 2.40), or diabetic (HR = 6.11; 95% CI: 4.47, 8.36).

CONCLUSIONS

In countries with a high endemicity of HBV infection, kidney damage associated with chronic HBV infection should be a non-negligible concern. Our findings also highlight the importance of health advice on quitting smoking, increasing physical activity, improving glucose control, and early screening for CKD in people with chronic HBV infection.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.Chinese Academy of Medical Sciences, Beijing, China.Chinese Academy of Medical Sciences, Beijing, China.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.Hunan Center for Disease Control & Prevention, Changsha, Hunan, China.Liuzhou Traditional Chinese Medical Hospital, Liuzhou, Guangxi, China.Liuzhou Center for Disease Control & Prevention, Liuzhou, Guangxi, China.China National Center for Food Safety Risk Assessment, Beijing, China.Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China. lvjun@bjmu.edu.cn. Peking University Institute of Environmental Medicine, Beijing, China. lvjun@bjmu.edu.cn.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China. Chinese Academy of Medical Sciences, Beijing, China.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29909773

Citation

Si, Jiahui, et al. "Chronic Hepatitis B Virus Infection and Risk of Chronic Kidney Disease: a Population-based Prospective Cohort Study of 0.5 Million Chinese Adults." BMC Medicine, vol. 16, no. 1, 2018, p. 93.
Si J, Yu C, Guo Y, et al. Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults. BMC Med. 2018;16(1):93.
Si, J., Yu, C., Guo, Y., Bian, Z., Qin, C., Yang, L., ... Li, L. (2018). Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults. BMC Medicine, 16(1), p. 93. doi:10.1186/s12916-018-1084-9.
Si J, et al. Chronic Hepatitis B Virus Infection and Risk of Chronic Kidney Disease: a Population-based Prospective Cohort Study of 0.5 Million Chinese Adults. BMC Med. 2018 06 18;16(1):93. PubMed PMID: 29909773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults. AU - Si,Jiahui, AU - Yu,Canqing, AU - Guo,Yu, AU - Bian,Zheng, AU - Qin,Chenxi, AU - Yang,Ling, AU - Chen,Yiping, AU - Yin,Li, AU - Li,Hui, AU - Lan,Jian, AU - Chen,Junshi, AU - Chen,Zhengming, AU - Lv,Jun, AU - Li,Liming, AU - ,, Y1 - 2018/06/18/ PY - 2017/11/29/received PY - 2018/05/23/accepted PY - 2018/6/19/entrez PY - 2018/6/19/pubmed PY - 2018/10/16/medline KW - Chronic hepatitis B virus infection KW - Chronic kidney disease KW - Prospective cohort study SP - 93 EP - 93 JF - BMC medicine JO - BMC Med VL - 16 IS - 1 N2 - BACKGROUND: Existing evidence remains inconclusive as to the association between chronic hepatitis B virus (HBV) infection and the risk of chronic kidney disease (CKD). We prospectively examined the association between chronic HBV infection and CKD risk, and the joint associations of HBV infection with established risk factors of several lifestyle factors and prevalent diseases on CKD risk. METHODS: Participants from the China Kadoorie Biobank were enrolled during 2004-2008 and followed up until 31 December 2015. After excluding participants with previously diagnosed CKD, cancer, heart disease, and stroke at baseline, the present study included 469,459 participants. Hepatitis B surface antigen (HBsAg) was qualitatively tested at baseline. Incident CKD cases were identified mainly through the health insurance system and disease and death registries. RESULTS: During a median follow-up of 9.1 years (4.2 million person-years), we documented 4555 incident cases of CKD. Cox regression yielded multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with HBsAg-negative participants, the multivariable-adjusted HR (95% CI) for CKD was 1.37 (1.18, 1.60) for HBsAg-positive participants. The association was stronger in men (HR = 1.77; 95% CI: 1.43, 2.20) than in women (HR = 1.10; 95% CI: 0.88, 1.36). HBsAg-positive participants, with or without hepatitis or cirrhosis, whether or not under treatment, all showed increased risk of developing CKD. We observed positive additive interactions of HBsAg positivity with smoking, physical inactivity, or diabetes on CKD risk. Compared with HBsAg-negative participants who were nonsmokers, more physically active, or did not have diabetes at baseline, the greatest CKD risk for HBsAg-positive participants was for those who were smokers (HR = 1.85; 95% CI: 1.44, 2.38), physically inactive (HR = 1.91; 95% CI: 1.52, 2.40), or diabetic (HR = 6.11; 95% CI: 4.47, 8.36). CONCLUSIONS: In countries with a high endemicity of HBV infection, kidney damage associated with chronic HBV infection should be a non-negligible concern. Our findings also highlight the importance of health advice on quitting smoking, increasing physical activity, improving glucose control, and early screening for CKD in people with chronic HBV infection. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/29909773/Chronic_hepatitis_B_virus_infection_and_risk_of_chronic_kidney_disease:_a_population_based_prospective_cohort_study_of_0_5_million_Chinese_adults_ L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1084-9 DB - PRIME DP - Unbound Medicine ER -