Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients.
OBJECTIVE
We examined the association between chronic hepatitis B virus (HBV) infection and clinical outcomes in a consecutive cohort of Chinese patients with type 2 diabetes.


METHODS
Between 1995 and 1999, 2,838 type 2 diabetes patients underwent comprehensive assessments and blood screening for hepatitis B surface antigen (HBsAg). The risk of occurrence of cardiovascular events and end-stage renal disease (defined as need for dialysis, doubling of serum creatinine or serum creatinine > or =500 micromol/l) was compared between HBsAg-positive and HBsAg-negative groups.


RESULTS
At baseline, HBV-infected patients (n=286, 10.1%) were younger (51.0+/-11.5 vs 53.7+/-12.7 years, p=0.004), had earlier onset of diabetes (51.0+/-11.5 vs 53.7+/-12.7 years, p=0.001) and a higher frequency of retinopathy (28 vs 22%, p=0.03) than non-HBV-infected patients. After a median follow-up of 3.5 years (interquartile range: 1.7-5.9 years) and adjustment of age, glycaemic control and other potential confounding factors, HBV-infected patients were more likely to develop end-stage renal disease than non-HBV infected patients (8.7 vs 6.4%) with a hazard ratio of 4.5 (95% CI 1.1-18.6). The difference in the frequency of cardiovascular endpoints was not statistically significant.


CONCLUSIONS
In Chinese type 2 diabetes patients, chronic HBV infection was associated with increased risk of end-stage renal disease, and this was independent of other potential confounding factors. Early identification of HBV status and close surveillance of renal function are important in patients with type 2 diabetes who are living in areas where HBV is endemic or who are at risk of chronic HBV infection.
Cheng
A Y S
AY
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People's Republic of China.
Kong
A P S
AP
Wong
V W S
VW
So
W Y
WY
Chan
H L Y
HL
Ho
C S
CS
Lam
C W K
CW
Tam
J S
JS
Chow
C C
CC
Cockram
C S
CS
Chan
J C N
JC
Tong
P C Y
PC
D017668:Age of Onset; D001774:Blood Chemical Analysis; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome
D006514:Hepatitis B Surface Antigens