Hepatitis E virus immunoglobulin G seropositivity and kidney dysfunction among United States adults

Background Hepatitis E virus infection is associated with renal manifestations in selected clinical populations. Whether serologic evidence of previous exposure is associated with kidney dysfunction in the general population remains uncertain. Methods We conducted a cross-sectional analysis of six National Health and Nutrition Examination Survey cycles from 2009–2018 and August 2021–August 2023. Adults aged ≥20 years with valid hepatitis E virus immunoglobulin G levels, serum creatinine levels, urinary albumin-to-creatinine ratios, and covariate data were included. The outcomes included a reduced estimated glomerular filtration rate (<60 mL/min/1.73 m2), albuminuria (albumin-to-creatinine ratio ≥30 mg/g [3.39 mg/mmol]), and their composite. Survey-weighted logistic regression models were unadjusted, adjusted for age and sex, and additionally adjusted for demographic and clinical covariates. Results Among 30,428 adults, 2,911 were seropositive; the weighted seroprevalence was 8.29%. The seropositive participants were older than the seronegative participants were (weighted mean, 60.7 versus 46.5 years). Seropositivity was associated with all three binary outcomes in unadjusted analyses, but the estimates approached the null after adjustment for age and sex. The fully adjusted odds ratios were 0.99 (95% confidence interval, 0.85–1.16) for a reduced filtration rate, 1.05 (0.91–1.22) for albuminuria, and 1.05 (0.93–1.19) for composite kidney dysfunction. In a secondary analysis, seropositivity was associated with a 1.57 mL/min/1.73 m2 higher adjusted mean filtration rate (95% confidence interval, 0.71–2.43). Conclusions Hepatitis E virus immunoglobulin G seropositivity was not significantly associated with binary kidney outcomes after adjustment. Attenuation occurred principally after adjustment for age and sex. These findings do not establish the absence of an association and do not address kidney injury during active or persistent infection.