Hepatitis B virus infection as a risk factor for chronic kidney disease

ABSTRACT

Introduction: Hepatitis B virus is an important cause of liver disease and has numerous extra-hepatic manifestations. HBV leads to important morbidity and mortality in the general population and recent evidence suggests a role of HBV in the incidence and progression of chronic kidney disease.

Areas covered: The mechanisms underlying the link between HBV and CKD remain unclear. Nucleos(t)ide analogues for the antiviral treatment of HBV are currently available; these drugs are provided with high efficacy even in patients with CKD.

Expert opinion: A recent meta-analysis of clinical studies showed that HBV results in a greater risk of CKD in the general population. According to an updated review (studies were identified from PubMed, EMBASE, and the Cochrane database), we retrieved six clinical studies (n = 1,034,773 unique patients), adjusted RR, 1.41 (95% CI, 1.09; 1.82, P < 0.001). The significant heterogeneity observed precluded more definitive conclusions. Various mechanisms have been cited to explain the greater risk of CKD among HBsAg positive carriers. Novel evidence shows that untreated HBV and therapy with nucleos(t)ide analogues are associated with increased and decreased risk of end-stage renal disease in CKD population, respectively. We recommend that patients with HBV are assessed for kidney function and urinary changes at baseline and over the follow-up.

KEY-WORDS:

• Chronic kidney disease
• End stage renal disease
• Hepatitis B virus
• Hepatitis C virus
• Meta-analysis

Article Highlights

• Kidneys are an important target of HBV infection and the correlation between HBV and CKD has bidirectional nature. Patients with CKD (particularly those on maintenance dialysis) have increased rates of HBV and HBV is a risk factor for CKD.

• RCTs are required in order to assess efficacy and safety of NAs in advanced CKD; however, the very low frequency of chronic HBsAg carriage among patients with advanced CKD of industrialized word makes difficult to carry out this type of studies.

• The association between CKD and HBV suggests the treatment of all HBV-infected patients, irrespective of their stage of kidney disease. We need more studies in order to assess whether the viral response obtained with NAs translates into better kidney survival.

• The first-line option for HBV-infected patients with CKD includes entecavir and tenofovir with a dosage adapted to the levels of kidney function. We suggest tenofovir alafenamide instead of tenofovir fumarate in patients with impaired glomerular filtration rate.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.