Abstract P064: Hepatitis C Infection Does Not Confer Elevated Risk of Chronic Kidney Disease Among Hispanics/Latinos: Findings From the Hispanic Community Health Study/Study of Latinos
Authors: Eugenia Wong, Ana C Ricardo, Nora Franceschini, James P Lash
Journal: Circulation (2019)

Background: Chronic kidney disease (CKD) is estimated to affect 14% of adults in the US, and there is a continued need to identify actionable risk factors for impaired kidney function. Viral infections, including hepatitis C, have been demonstrated to cause secondary glomerular nephropathies, such as cryoglobulinemia. However, there has been conflicting evidence of causal associations between hepatitis C infection (HCV) and incident CKD. Furthermore, this relationship has not been well-studied in individuals of Hispanic or Latino descent. Hypothesis: We hypothesized that hepatitis C infection would be positively associated with incident CKD among Hispanics/Latinos. Methods: The study population was comprised of 11,120 participants of the Hispanic Community Health/Study of Latinos (HCHS/SOL), a cohort of adults sampled from four regions across the US. The cohort was 63% female, and mean age at baseline (2008-2011) was 47 years. HCV seropositivity was defined by detectable HCV antibodies and confirmation with either recombinant immunoblot assay (RIBA) testing or detectable HCV RNA. Individuals were determined to have CKD if they had estimated glomerular filtration rate &lt;60 mL/min/1.73 m 2 and albumin/creatinine ratio &gt;30mg/g. Those with prevalent CKD at baseline were excluded from the analysis. Logistic regressions were performed to estimate the odds ratios (OR) and 95% confident intervals [95% CI] of CKD at Visit 2 (2015-2017). Estimates were adjusted for demographic factors including age, gender, and self-reported heritage/background. Adjustments were also made for baseline educational attainment, smoking behaviors, body mass index, prevalent diabetes, and prevalent hypertension. Results: Over a median follow-up of 5.9 years, 202 cases of CKD occurred. Incident CKD was proportionally, more common among HCV infected individuals: 8 of 116 (6.9%) HCV seropositives experienced CKD, in contrast to 194 cases (1.8%) among the 11,004 non-infected individuals. The crude odds ratio of CKD among HCV infected participants was more than 4 times that of uninfected participants (OR 4.51 [1.97-10.34]). After adjustment for demographic factors, such as age and self-reported heritage, HCV infection continued to be associated with increased risk (OR 2.45 [1.02-5.89]). However, after further controlling for comorbid conditions, the odds ratio of CKD among HCV seropositives was attenuated and no longer significant (OR 2.25 [0.87-5.84]). Diabetes (OR 4.91 [2.73-8.83]) and hypertension (OR 2.22 [1.32-3.74]) were significantly associated with incident CKD. Conclusion: Among individuals of Hispanic/Latino origin, hepatitis C infection does not appear to be associated with increased risks of CKD. These results imply that primary and secondary prevention of diabetes and hypertension may hold higher priority than treatment HCV infection in efforts to prevent CKD among Hispanics/Latinos.