Global prevalence of chronic kidney disease and its influencing factors among chronic hepatitis B: a systematic review and meta-analysis

BACKGROUND: A comprehensive understanding of the prevalence of chronic kidney disease (CKD) among patients with chronic hepatitis B (CHB) is lacking. To fill this knowledge gap, we conducted a systematic review and meta-analysis to assess the prevalence of CKD and its associated factors among CHB patients. METHODS: Following the PRISMA guidelines, we conducted a comprehensive search for literature published between January 1, 2010, and January 5, 2025, in databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang. The prevalence of CKD among CHB individuals was used as the statistical effect size, and the 95% confidence interval (CI) was calculated. Additionally, we compared the risk of CKD between CHB and non-HBV-infected populations, expressed as odds ratios (OR). Furthermore, subgroup analyses were performed based on factors such as year of publication, study sample size, age, CKD diagnostic basis, country, WHO region, economic status, presence of cirrhosis, diabetes, and antiviral treatment status to further explore the influencing factors of CKD among CHB individuals. Subgroup results were corrected using Holm–Bonferroni correction, and meta-regression was used to explore sources of heterogeneity. RESULTS: A total of 41 studies were included in our analysis, of which 30 were deemed high-quality. These studies collectively encompassed 1,066,919 CHB patients, among whom 44,021 were diagnosed with CKD. The meta-analysis demonstrated a significantly elevated CKD risk in CHB populations versus non-hepatitis B controls (OR = 2.30, 95%CI: 2.01–2.63). Due to substantial between-study heterogeneity, we performed subgroup analyses which revealed: the highest prevalence in studies published during 2021–2024 (11.48%, 95%CI: 6.08%-21.61%); numerically but non-significantly higher prevalence in patients aged ≥ 50 years (21.87%, 95%CI:0.41%-64.78%) versus younger patients (4.68%, 95%CI: 0.50%-32.57%, p > 0.05) and in diabetic (17.78%, 95%CI: 1.91%-70.58%) versus non-diabetic patients (1.52%, 95%CI: 0.61%-3.69%, p > 0.05). CKD prevalence was significantly higher when diagnosed by persistent eGFR < 60 mL/min/1.73 m² (12.20%, 95%CI: 6.04%-23.09%) versus other criteria. Antiviral-treated patients showed higher prevalence (11.37%, 95%CI:8.62%-14.86%) than untreated counterparts (4.09%, 95%CI:2.63%-6.31%). Meta-regression identified age, diabetes status and antiviral treatment as heterogeneity sources. CONCLUSIONS: This study reveals a higher prevalence of CKD in patients with CHB. Subgroup analysis indicated that groups with cirrhosis, diabetes, and a history of antiviral therapy exhibited even higher prevalence rates. These findings suggest that individualized management strategies tailored to specific subgroups of CHB patients may enhance the prevention and management of comorbid conditions. However, due to age, region, and other natural differences in populations, the observed prevalence shows great heterogeneity. Therefore, the results should be interpreted with caution given the high degree of heterogeneity.