A review of adults with chronic hepatitis B who had continuous medical coverage showed that the presence of extrahepatic comorbidities such as hypertension, cardiovascular disease and diabetes were among the primary risks for chronic kidney disease.
“Understanding the care of clinically complex [chronic HBV (CHB)] patients is especially relevant since the rate of screening, diagnosis, and linkage to care for CHB patients is poor,” Mindie H. Nguyen, MD, MAS, AGAF, FAASLD, from the Stanford University Medical Center in California, and colleagues wrote. “Due to this often-delayed diagnosis and treatment, CHB patients are now presenting at an older age and with more liver and non-liver comorbidities that can further complicate their management.”
To characterize the demographics and presence non-liver related comorbidities in patients with chronic HBV, Nguyen and colleagues reviewed data on adult patients with commercial, Medicare or Medicaid insurance in the U.S. between 2006 and 2015 and compared the results with a matched control cohort.
The most common comorbidities among the patients with chronic HBV and the control group were hypertension, hyperlipidemia and diabetes, all of which increased over time.
While the use of associated comorbidity medications increased significantly over the time period (P < .01), the researchers found that overall treatment among the patient group was low, with approximately 25% of those with commercial or Medicare insurance and 14% with Medicaid having received treatment.
Patients with commercial or Medicare insurance who received treatment were younger than those who did not and were less likely to have cardiovascular disease, hypertension, hyperlipidemia, obesity or chronic kidney disease, but were more likely to develop advanced liver disease (16.4% vs. 11.2%; P < .001).
Patients with Medicaid who received treatment were a similar age as those who did not, but were more likely to have hepatitis C (33.6% vs. 23.9%; P < .001) and HIV (30.2% vs. 14.2%; P < .0001).
Both the prevalence and incidence of CKD increased among patients with chronic HBV between 2006 and 2015. By 2015, patients with commercial or Medicare insurance had a significantly higher prevalence (97.6 vs. 33.8 per 1,000 persons; P < .05) and incidence (15.2 vs. 11.3 per 1,000 person-years; P < .05) compared with the control group. Similarly, patients with Medicaid had higher prevalence (173 vs. 100.6 per 1,000 persons; P < .05) and incidence rates (39.1 vs. 22.7 per 1,000 person-years; P < .05) compared with controls.
Multivariate analysis showed that older age (HR = 1.04; 95% CI, 1.35-1.41), Medicaid coverage (HR = 1.71; 95% CI, 1.59-1.83), years of follow-up (HR = 1.04; 95% CI, 1.02-1.05), coinfection with HCV or HIV (HR = 1.8; 95% CI, 1.63-1.98), diabetes (HR = 2.47; 95% CI, 2.32-2.62), hypertension (HR = 3.35; 95% CI, 3.09-3.63), and cardiovascular disease (HR = 2.61; 95% CI, 2.44-2.78) correlated with an increased risk for CKD in patients with chronic HBV.
“An interesting result from our study was that female gender appeared to be protective of CKD,” Nguyen and colleagues wrote, referring to a 19% lower rate compared with men, “a finding that certainly needs further study to determine the impact of gender and HBV on CKD. In addition, further effort is needed to identify and link CHB patients to care at a younger age when in a healthier state to avoid the complex management of the older patient with significant non-liver comorbidities.” – by Talitha Bennett
Disclosure: Nguyen reports she has received research support from Bristol-Myers Squibb, Gilead, Janssen and Pfizer; and is a consultant or advisor for Bayer, Bristol-Myers Squibb, Dynavax, Gilead, Intercept, Janssen, Novartis and Roche. Please see the full study for the other authors’ relevant financial disclosures.