We assessed the risk of chronic kidney disease (CKD) in chronic hepatitis C virus (HCV)‐infected patients and the incidence reduction of CKD after receipt of HCV treatment. We also evaluated the risk of membranoproliferative glomerulonephritis (MPGN) and cryoglobulinemia in chronic HCV patients. A retrospective cohort analysis of the Truven Health MarketScan Database (2008‐2015) in the United States was conducted. In a cohort of 56,448 HCV‐infected patients and 169,344 propensity score (1:3)–matched non‐HCV patients, we examined the association of HCV infection with the incidence of CKD. Of 55,818 HCV patients, 6.6 % (n = 3666), 6.3% (n = 3534), and 8.3% (n = 4628) patients received either interferon‐based dual, triple, or all‐oral direct acting antiviral agent therapy, respectively, whereas 79% of patients did not receive any HCV treatment. Cox proportional hazards models were used to compare the risk of developing CKD in HCV patients compared with non‐HCV patients and treated patients compared with untreated HCV patients. In a multivariate time‐varying Cox regression model, HCV‐infected patients had a 27% increased risk of CKD compared with non‐HCV patients (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.18‐1.37). Among HCV patients, individuals who received the minimally effective HCV treatment for dual, triple, or all‐oral therapy had a 30% decreased risk of developing CKD (HR, 0.70; 95% CI, 0.55‐0.88). In addition, HCV‐infected patients experienced a twofold and a nearly 17‐fold higher risk of MPGN (HR, 2.23; 95% CI, 1.84‐2.71) and cryoglobulinemia (HR, 16.91; 95% CI, 12.00‐23.81) respectively, compared with non‐HCV patients. Conclusion: HCV‐infected individuals in the United States are at greater risk of developing CKD, MPGN, and cryoglobulinemia. Minimally effective treatment of HCV infection can prevent the development of CKD, although the association was not significant for all‐oral therapy. (Hepatology 2018;67:492‐504).

中文翻译：

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慢性丙型肝炎会增加慢性肾脏病 (CKD) 的风险，而有效的 HCV 治疗可降低 CKD 的发生率

我们评估了慢性丙型肝炎病毒 (HCV) 感染患者的慢性肾脏病 (CKD) 风险以及接受 HCV 治疗后 CKD 发生率的降低。我们还评估了慢性 HCV 患者发生膜增生性肾小球肾炎 (MPGN) 和冷球蛋白血症的风险。对美国的 Truven Health MarketScan 数据库（2008-2015）进行了回顾性队列分析。在 56,448 名 HCV 感染患者和 169,344 名倾向评分 (1:3) 匹配的非 HCV 患者的队列中，我们检查了 HCV 感染与 CKD 发病率的关联。在 55,818 名 HCV 患者中，分别有 6.6% (n = 3666)、6.3% (n = 3534) 和 8.3% (n = 4628) 的患者接受了基于干扰素的双重、三重或全口服直接作用抗病毒药物治疗，而 79% 的患者未接受任何 HCV 治疗。Cox 比例风险模型用于比较 HCV 患者与非 HCV 患者以及接受治疗的患者与未接受治疗的 HCV 患者相比发生 CKD 的风险。在多变量时变 Cox 回归模型中，与非 HCV 患者相比，HCV 感染患者的 CKD 风险增加了 27%（风险比 [HR]，1.27；95% 置信区间 [CI]，1.18-1.37）。在 HCV 患者中，接受最低有效 HCV 治疗进行双重、三重或全口服治疗的个体患 CKD 的风险降低了 30%（HR，0.70；95% CI，0.55-0.88）。此外，HCV 感染患者患 MPGN（HR，2.23；95% CI，1.84-2.71）和冷球蛋白血症（HR，16.91；95% CI，12.00-23.81）的风险分别高出两倍和近 17 倍，与非 HCV 患者相比。结论：在美国，HCV 感染者发生 CKD、MPGN 和冷球蛋白血症的风险更大。HCV 感染的最低有效治疗可以预防 CKD 的发展，尽管这种关联对于全口服治疗并不显着。（肝病学 2018 年；67：492-504）。