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.

Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Cardiovascular Mortality in Chronic Kidney Patients: the Role of Uremic Toxins / Mortalidade Cardiovascular em Pacientes Renais Crônicos: o Papel das Toxinas Urêmicas

A doença cardiovascular (DCV) é a maior causa de morte nos pacientes com doença renal crônica (DRC) nomundo. Vários fatores estão associados a essa elevada mortalidade e, recentemente, as toxinas urêmicas produzidas pela microbiota intestinal têm recebido bastante atenção, já que a falência renal cursa com o acúmulo dessas toxinas no plasma. Essas toxinas têm relação com estresse oxidativo, inflamação, disfunção endotelial e induçãoda aterosclerose e, recentes estudos têm observado que pacientes com elevados níveis de tais toxinas têm aumento na mortalidade por DCV. Assim, o objetivo da presente revisão foi discutir o papel das toxinas urêmicasprovenientes da microbiota intestinal e seu impacto na mortalidade cardiovascular em pacientes renais crônicos, bem como as possíveis perspectivas terapêuticas que podem ser elucidadas a partir do conhecimento aprofundado do tema...

The cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) in the world. Several factors are associated with this high mortality. Recently, the uremic toxins produced by intestinal microbiota have received extensiveattention from researchers, since kidney failure evolves with the accumulation of these toxins in the plasma. These toxins are related to oxidative stress, inflammation, endothelial dysfunction, and induction of atherosclerosis, and recent studies have noted thatpatients with high levels of these toxins have increased mortality due to CVD. Therefore, the purpose of this review was to discuss the role of uremic toxins from the intestinal microbiota and their impact on cardiovascular mortality in CKD patients, as well as the possible therapeutic perspectives that can be explained based on an in-depth understanding of the subject...