| Background:Chronic kidney disease(CKD)is one of the public health problems that seriously threaten human health and has a high risk of complicating with cardiovascular disease and developing into end-stage kidney disease,even death.CKD rose from the 27th leading cause of death worldwide in 1990 to the 18th in 2010.The prevalence rate of CKD in adults was estimated to be 10%to 15%,with an increasing trend year by year.From 2003 to 2012,the prevalence rate of CKD in the United States increased from 11%to 13.6%,and in China,the prevalence rate of CKD was 10.8%in 2010.Kidney damage can occur in about 10%to 20%of patients who was infected with chronic hepatitis B virus(HBV),and eventually progressing to CKD and end-stage kidney disease.However,China is a large country with HBV infection,about 100 million people are currently infected with HBV.At present,there are relatively few research data on Chronic hepatitis B(CHB)complicated with CKD in China,and there are no reports on CHB complicated with CKD in east China.This study,for the first time,reviewed the clinical data of CHB patients complicated with CKD among the inpatients in qilu hospital of shandong university from January 2013 to December 2017,aiming to evaluate the prevalence rate and risk factors of CKD in the target population.obj ective:1.To evaluate the prevalence rate of CHB complicated with CKD;2.To explore the risk factors of CHB complicated with CKD.Methods:1.Data collection:Collected the clinical data of CHB patients in Qilu Hospital of Shandong University from January 1,2013 to December 31,2017(n=642).Inclusive criteria:①age≥8 years old,②hepatitis B surface antigen(HBsAg)positive and diagnosed as CHB,③ no history of kidney disease(except hepatitis B virus-associated glomerulonephritis(HBV-GN)which has been pathologically diagnosed by renal biopsy),④no hepatitis C virus(HCV),hepatitis D virus(HDV)or human immunodeficiency virus(HIV)infection was found,⑤no urinary tract infection,⑥no history of tumor.Clinical data of patients included general demographic data(name,age and sex),past medical history(whether to accept antiviral treatment,antiviral treatment time and drugs,liver cirrhosis,diabetes,hypertension and coronary heart disease),course of disease and laboratory index(blood routine,urine routine,liver function,renal function,HBV-related serological examination,prothrombin activity,alpha fetoprotein and blood lipid).Estimation of glomerular filtration rate(eGFR)by using the equation developed by the United States Cooperative Working Group on Chronic Kidney Disease Epidemiology(CKD-EPI),according to the gender,age and blood creatinine level of these patients.2.Statistical methods:In this study,classification variables were expressed as percentages(%),continuous variables were represented by the interquartile(IQR).Whitney rank sum test and Pearson test were used to compare the two groups.Logistic regression model was established to analyze the relationship between exposure covariates and CKD in CHB patients.All statistical tests were bilateral,and statistical P<0.05 was defined as statistically significant.Results:From January 2013 to December 2017,a total of 3,655 patients in qilu hospital of shandong university were diagnosed as CHB,and 642 patients were included in this study through inclusion criteria and exclusion criteria.The average age of these patients was 44.00(35.25-54.00)years old,498 cases were male,accounting for 77.57%of the total number.The overall prevalence rate of proteinuria(urine protein≥ 1+ in urine routine)and impaired renal function(eGFR<60 mL/min*1.73 m2)and CKD(eGFR<60mL/min*1.73 m2 and/or urine protein≥1+)in CHB patients was 14.02%(90/642),3.43%(22/642)and 14.64%(94/642).The prevalence rate of diabetes mellitus was 9.50%(61/642),hypertension was 10.44%(67/642),and dyslipidemia was 19.94%(128/642).The results showed that CHB patients with liver cirrhosis were younger and had higher levels of glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,serum albumin,hepatitis B e antigen(HBeAg)quantification,hemoglobin,prothrombin activity,HBV-DNA quantification,total cholesterol,triglyceride,low-density lipoprotein and cystatin C.Meanwhile,CHB patients without liver cirrhosis had higher uric acid(P=0.035)and serum creatinine(P=0.03),and HBV-DNA positive(P=0.003),HBeAg positive and kidney function impaired more.In univariate logistic regression analysis,HBsAg level,course of disease(10 years or more),dyslipidemia,hypertension and diabetes mellitus were risk factors for CHB complicated with CKD.In addition,in multivariate logistic regression analysis,HBeAg positive(OR 2.099,P=0.019),hypertension(OR 12.523,P<0.001)and dyslipidemia(OR 3.025,P<0.001)were independent risk factors for CHB complicated with CKD.In patients without diabetes mellitus,hypertension,or coronary heart disease,univariate logistic regression analysis showed that disease duration(>10 years),HBsAg level,and dyslipidemia were risk factors for CHB complicated with CKD.While multivariate logistic regression analysis showed that dyslipidemia(OR 2.999,P=0.002)was an independent risk factor for CHB complicated with CKD.Conclusions:1.In this study,the prevalence rate of CKD in CHB patients was 14.64%,higher than the general population.2.HBeAg positive,dyslipidemia and hypertension,their P values were all less than 0.05,OR value and 95%CI value were significantly greater than 1,indicating that they were independent risk factors for CHB complicated with CKD.3.Assessing kidney damage with serum creatinine alone may ignore most patients with normal GFR who have CHB complicated with CKD. |
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