title: Association between hepatitis B virus and chronic kidney disease: a systematic review and meta-analysis.
abstract: Background. Hepatitis B virus infection and chronic kidney disease are prevalent and remain a major public health problem worldwide. It remains unclear how infection with hepatitis B virus impacts on the development and progression of chronic kidney disease.
  
  
  OBJECTIVE
  To evaluate the effect of infection with HBV on the risk of chronic kidney disease in the general population.
  
  
  METHODS
  We conducted a systematic review of the published medical literature to determine if hepatitis B infection is associated with increased likelihood of chronic kidney disease. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) with hepatitis B virus across the published studies. Meta-regression and stratified analysis were also conducted.
  
  
  RESULTS
  We identified 16 studies (n = 394,664 patients) and separate meta-analyses were performed according to the outcome. The subset of longitudinal studies addressing ESRD (n = 2; n = 91,656) gave a pooled aHR 3.87 (95% CI, 1.48; 6.25, P < 0.0001) among HBV-infected patients and no heterogeneity was recorded. In meta-regression, we noted the impact of male (P = 0.006) and duration of follow- up (P = 0.007) upon the adjusted hazard ratio of incidence of chronic kidney disease (including end-stage renal disease). No relationship occurred between HBV positive status and prevalent chronic disease (n = 7, n = 109,889 unique patients); adjusted odds ratio, were 1.07 (95% CI, 0.89; 1.25) and 0.93 (95% CI, 0.76; 1.10), respectively.
  
  
  CONCLUSIONS
  HBV infection is possibly associated with a risk of developing reduced glomerular filtration rate in the general population; no link between HBV sero-positive status and frequency of chronic kidney disease or proteinuria was noted in cross-sectional surveys.
authors.affiliation: Division of Nephrology Maggiore Hospital and IRCCS Foundation, Milano, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.affiliation: Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Milano, Italy.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Donato
authors.affiliation: Division of Nephrology Maggiore Hospital and IRCCS Foundation, Milano, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000821:virology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016017:Odds Ratio; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology / Q000821:virology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors