Chronic hepatitis B virus infection increases the risk of kidney disease while antiviral therapy for hepatitis B...

Extrahepatic manifestations of chronic hepatitis B virus (HBV) infection include development of kidney disease (KD). While anti-HBV treatment reduces the risk of liver-related events, the impact of HBV treatment on KD remains unclear. Using a large US-based electronic medical record (EMR) database, we examined whether patients with HBV are at higher risk of developing KD, whether the development of KD is associated with HBV-related liver disease, and whether anti-HBV treatment mitigates these risks.

Data were queried from the IQVIA Ambulatory EMR database from 2006 to 2020. Propensity score matching was performed to better ensure balance across analyses. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs for onset of KD between groups.

Among patients with and without HBV (n = 11,772 each), those with HBV were more than twice as likely to develop KD vs. matched controls without HBV infection (HR, 2.18 [95% CI, 1.90-2.50]; p < 0.001); most events occurred after age 55 years. Patients with HBV and concomitant hypertension, diabetes, or obesity had a greater likelihood for development of KD by age 75 years (19% with HBV vs. 6% without HBV); the cumulative probability of developing KD among patients with HBV along with concomitant comorbidities surpassed the additive risk of developing KD among those who had the comorbidities without HBV or only had HBV. Among patients with HBV, advanced liver disease was not significantly associated with KD. Patients treated with antivirals had a lower risk for KD compared with untreated HBV patients (HR, 0.61 [95% CI, 0.42-0.87]; p < 0.01).

HBV infection contributes to the development of KD, and anti-HBV treatment can lower KD risk. As such, clinicians should consider screening patients for HBV infection or initiating treatment early, particularly in patients with risk factors for KD.