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Hepatitis C Is a Predictor of Poorer Renal Survival in Diabetic Patients

¹ Departments of Medicine, Divisions of Nephrology, Wayne State University School of Medicine, Detroit, Michigan
² John D. Dingell VA Medical Center, Detroit, Michigan
³ Detroit Medical Center, Detroit, Michigan

Address correspondence and reprint requests to Errol D. Crook, MD, Department of Internal Medicine, University of South Alabama, Mastin 400 A, 2451 Fillingim St., Mobile, AL 36617. E-mail: ecrook{at}usouthal.edu

OBJECTIVE—Hepatitis C virus (HCV) is highly prevalent in the U.S. and worsens renal survival in some kidney diseases. We examined the effects of HCV on renal survival in diabetic patients with renal disease.

RESEARCH DESIGN AND METHODS—HCV and diabetes status were noted in patients seen in our nephrology clinic in 2001 and 2002. Charts of diabetic patients were reviewed for demographics, blood pressure, renal function, medicines, the presence of HCV, and other factors at the initial visit and over follow-up. The effect of HCV on renal survival was determined by Cox proportional hazards, using end-stage renal disease (ESRD) as an end point.

RESULTS—Of 1,127 patients, prevalence rates for HCV were higher in African Americans than non–African Americans (8.09 vs. 3.93%, respectively, P = 0.06), with African-American men having the highest prevalence rates (12.7%). The charts of 312 diabetic patients were reviewed. Over 80% were African American, as were 23 of 24 patients with HCV. Compared with non-HCV patients, HCV patients were younger, had higher diastolic blood pressure, and had lower BMI. HCV patients had significantly worse cumulative renal survival by Kaplan-Meier. On Cox proportional hazards analysis, HCV was a significant predictor of reaching ESRD independent of initial renal function, proteinuria, blood pressure, sex, race, presence of diabetic nephropathy, age, or duration of diabetes (odds ratio 3.49, 95% CI 1.27–9.57, P = 0.015).

CONCLUSIONS—HCV is common in African Americans with diabetes and renal disease and is an independent risk factor for renal survival in this population. Prospective studies are necessary to confirm these observations.

Abbreviations: CKD, chronic kidney disease • ESRD, end-stage renal disease • GFR, glomerular filtration rate • HCV, hepatitis C virus • MPGN, membraneoproliferative glomerulonephritis

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