Chronic Hepatitis C and Chronic Kidney Disease

Excerpt

Chronic kidney disease (CKD) has long been under-detected. The benefits of early detection include earlier treatment and patient education, so that co-morbidities associated with CKD can be prevented, and progression to end-state kidney disease can be slowed down. This is particularly relevant to chronic disease states that are known to be associated with CKD, such as chronic hepatitis C. In the manuscript titled “Increased prevalence of reduced estimated glomerular filtration rate in chronic hepatitis C” by Petre et al. [1], the authors analyzed a cohort of 831 consecutive patients in the outpatient clinic with chronic hepatitis C to assess the prevalence of reduced estimated glomerular filtration (eGFR). The authors reported that more than half of patients had depressed eGFR, with a predominance of patients (36.4%) in the GFR range of stage 2 CKD (60–89 ml/min/1.73 m²). In contrast, only one-third of patients had estimated creatinine clearance <90 ml/min/1.73 m² if the Cockcroft–Gault method were applied, with 18% classified as CKD stage 2. The authors conclude that, in patients with chronic hepatitis C, a serum creatinine concentration in the normal range (≤1.4 mg/dl as reported in their clinical laboratory) does not assure normal kidney function, at least as determined by eGFR. However, a hyperbolic, inverse relationship between true GFR and serum creatinine concentrations limits accuracy of eGFR when the latter concentration is in the normal or near-normal range, leading substantial underestimation by eGFR of the actual GFR [2]. Thus, it is likely that the percent of patients with chronic hepatitis C in the Petre study who have true glomerular hypofiltration is an over-estimation. …