Association Between Hepatitis B Virus and Chronic Kidney Disease: a Systematic Review and Meta-analysis

Abstract: Background. Hepatitis B virus infection and chronic kidney disease are prevalent and remain a major public health problem worldwide. It remains unclear how infection with hepatitis B virus impacts on the development and progression of chronic kidney disease. Aim. To evaluate the effect of infection with HBV on the risk of chronic kidney disease in the general population. Material and methods. We conducted a systematic review of the published medical literature to determine if hepatitis B infection is associated with increased likelihood of chronic kidney disease. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) with hepatitis B virus across the published studies. Meta-regression and stratified analysis were also conducted. Results. We identified 16 studies (n = 394,664 patients) and separate meta-analyses were performed according to the outcome. The subset of longitudinal studies addressing ESRD (n = 2; n = 91,656) gave a pooled aHR 3.87 (95% CI, 1.48; 6.25, P < 0.0001) among HBV-infected patients and no heterogeneity was recorded. In meta-regression, we noted the impact of male (P = 0.006) and duration of follow-up (P = 0.007) upon the adjusted hazard ratio of incidence of chronic kidney disease (including end-stage renal disease). No relationship occurred between HBV positive status and prevalent chronic disease (n = 7, n = 109,889 unique patients); adjusted odds ratio, were 1.07 (95% CI, 0.89; 1.25) and 0.93 (95% CI, 0.76; 1.10), respectively. Conclusions. HBV infection is possibly associated with a risk of developing reduced glomerular filtration rate in the general population; no link between HBV sero-positive status and frequency of chronic kidney disease or proteinuria was noted in cross-sectional surveys.

End-stage Renal Disease Costs for Patients New to Hemodialysis in Italy: The FARO-2 Study.

Background: Increasing incidence and prevalence of end-stage renal disease (ESRD) together with the presence of several comorbidities in chronic kidney disease patients (CKD) could be associated with a relevant economic burden. Aim: The aim of this analysis was to estimate the direct healthcare costs of ESRD and its major comorbidities in Italian patients who were naïve to hemodialysis (HD) recruited for the FARO-2 study. Methods: The FARO-2 study was a retrospective observational study conducted in Italy that evaluated the patterns of treatment of secondary hyperparathyroidism (SHPT) and related costs in patients naïve to HD. The observational period was 2006–2008. Costs were measured in Euros (reference year: 2008). Resource use for the first 2 periods of 6 months of HD was monetized, with reimbursement calculated for SHPT drugs, phosphate binders, and erythropoietin-stimulating agents (ESAs); HD sessions; and hospitalizations due to ESRD and its major comorbidities. The analysis was performed by the Italian National Health Service (INHS) perspective. Results: 567 patients were observed for at least 2 periods of 6 months. During the first 12 months after the initiation of HD, average direct healthcare costs were assessed using the percentage of patients treated and the average daily dosages (for drugs), the percentage of patients hospitalized and the types of hospitalizations (for inpatients), and the average weekly frequency of HD sessions. Total per-patient yearly costs totaled 34,789.9 €: HD accounted for 66.1% of expenditures, with hospitalizations and drugs accounting for 12.9% and 21.0% of expenditures, respectively (including 17.1% for ESAs). Conclusions: Patients naïve to HD have a significant impact on Italian National Health Service expenditures, although only the costs related to treatment of ESRD and its comorbidities were calculated in the present study. The major cost drivers were HD and ESAs, while SHPT drugs and phosphate binders together accounted for only 3.9% of direct healthcare expenditures.

Importancia de los anticuerpos antifosfolípidos en el compromiso renal de los pacientes con nefritis lúpica / Antiphospholipid antibodies and kidney involvement in patients with lupus nephritis

Se ha descrito un espectro amplio de manifestaciones clínicas en asociación con los anticuerpos antifosfolípidos (Ac aFL), como estenosis de la arteria renal, infarto renal, trombosis de la vena renal y el cuadro descrito más recientemente, "nefropatía por anticuerpos antifosfolípidos" (NAAF): lesiones vasooclusivas de los vasos intrarrenales que asocian trombosis agudas con lesiones arteriolares crónicas que conducen a una zona de atrofia isquémica cortical. Se ha demostrado que la NAAF aguda y crónica se asocia significativamente con la presencia de Ac aFL en pacientes con nefritis lúpica. Desde un punto de vista clínico las manifestaciones renales de la nefritis lúpica y las de las NAAF pueden ser similares. Se observa más a menudo insuficiencia renal e hipertensión de la NAAF, mientras que la proteinuria y la hematuria son más frecuentes en la nefritis lúpica. El impacto de los Ac aFL sobre la historia natural de la nefritis lúpica está lejos de ser claro En teoría, las lesiones renales histológicas producidas por Ac aFL como la aparición de hipertensión arterial persistente en una cantidad importante de pacientes positivos para Ac aFL con nefritis lúpica deben considerarse elementos de predicción de mal pronóstico renal. En nuestra experiencia, después de un seguimiento medio de 14 años. el 45% de los pacientes Ac aFL positivos comparados con el 19,5% de los pacientes negativos (p=0.01) sufrieron insuficiencia renal crónica.