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Increased prevalence of reduced estimated glomerular filtration rate in chronic hepatitis C patients
Sorin A Petre1, Mankanwal S Sachdev, Brie N Noble
1The Division of Transplantation Medicine, Mayo Clinic Hospital, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA.
Insights
Chronic hepatitis C patients often have reduced kidney function, even with normal creatinine levels. Estimating glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (aMDRD) equation is crucial for accurate chronic kidney disease screening in CHC patients.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Chronic hepatitis C (CHC) is a significant global health concern.
- Kidney dysfunction is an underrecognized complication in CHC patients.
- Investigating the prevalence and severity of reduced estimated glomerular filtration rate (eGFR) in CHC is essential.
Purpose of the Study:
- To determine the prevalence and severity of reduced eGFR in patients with CHC.
- To evaluate the utility of the abbreviated Modification of Diet in Renal Disease (aMDRD) equation for assessing kidney function in CHC.
- To highlight the importance of rigorous kidney function screening in CHC patients.
Main Methods:
- Retrospective medical record review of 831 CHC patients.
- eGFR calculated using the aMDRD equation.
- Kidney disease staging based on eGFR values (mL/min/1.73 m²).
Main Results:
- 51% of 522 CHC patients had abnormal eGFR.
- Stage 2 kidney disease (eGFR 60-89) was prevalent (36.4%), often with normal serum creatinine.
- Reduced eGFR was observed even in patients without known renal insufficiency causes (38% had stage 2-4 disease).
Conclusions:
- Normal serum creatinine does not rule out kidney impairment in CHC patients.
- The aMDRD equation is a more reliable tool for identifying reduced eGFR and chronic kidney disease (CKD) in CHC.
- Routine eGFR assessment using aMDRD is recommended for all CHC patients to ensure comprehensive renal function evaluation.
Background:
To investigate the prevalence and severity of reduced estimated glomerular filtration rate (eGFR) in patients with chronic hepatitis C (CHC).
Methods:
Medical record review of 831 consecutive CHC patients seen in our clinic between July 2000 and August 2003; eGFR was estimated using the abbreviated Modification of Diet in Renal Disease (aMDRD) equation. The stage of kidney disease was determined based on eGFR expressed in milliliters per minute per 1.73 m(2): stage 1 (signs of kidney damage but normal or elevated (eGFR >or= 90), stage 2 (eGFR 60-89), stage 3 (30-59), stage 4 (eGFR 15-29), stage 5 (eGFR < 15 or dialysis-dependent).
Results:
A total of 522 patients had available data with using the aMDRD equation, 51% had abnormal eGFR (stage 1, 4.6%; stage 2, 36.4%; stage 3 or 4, 6.1%; stage 5, 3.8%). Of 190 patients with stage 2 kidney disease, 189 patients (99.5%) had normal serum creatinine and only one patient (0.5%) had elevated creatinine concentrations (>1.4 mg/dl). Of the 32 patients with stage 3 or 4 disease, 20 (62.5%) had a normal serum creatinine concentration. Of 349 patients without diseases known to cause renal insufficiency, 38% had stage 2-4 renal disease. In a subset of these patients, 95/522 (18%) the measured creatinine clearance showed good correlation with their aMDRD (R = 0.47, (p < 0.0001).
Conclusions:
In CHC patients, a normal serum creatinine concentration does not assure normal kidney function. Estimation of eGFR with the aMDRD equation is a more accurate method of identifying patients with chronic kidney disease and reduced eGFR. Therefore, CHC patients should be screened more rigorously for chronic kidney disease because of the high prevalence of reduced eGFR. Lastly, in all CHC patients, the aMDRD eGFR should be used in each encounter with these patients when assessing their renal function irrespective of their serum creatinine.
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