Impact of hepatitis C on survival in dialysis patients: a link with cardiovascular mortality?

Abstract

Summary. Recent evidence has been accumulated showing that anti‐HCV‐positive serologic status is significantly associated with lower survival in dialysis populations, but the mechanisms underlying this negative relationship are still unclear. The aim of this study was to conduct a systematic review of the published medical literature concerning the impact of hepatitis C virus (HCV) infection on all‐cause and disease‐specific mortality of patients on regular dialysis. The relative risk of all‐cause, cardiovascular and liver disease‐related mortality was regarded as the most reliable outcome end‐point. Study‐specific relative risks were weighted by the inverse of their variance to obtain fixed‐ and random effect pooled estimates for mortality with HCV across the published studies. We identified fourteen observational studies involving 145 608 unique patients on long‐term dialysis. Pooling of study results demonstrated that anti‐HCV antibody was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for adjusted relative risk (all‐cause mortality) was 1.35 with a 95% confidence interval (CI) of 1.25–1.47. Stratified analysis showed that the adjusted RR for liver disease‐related death was 3.82 (95% CI, 1.92; 7.61); heterogeneity statistics, Ri = 0.58 (P‐value by Q‐test = 0.087). The adjusted RR for cardiovascular mortality was 1.26 (95% CI, 1.10; 1.45); no heterogeneity was found (NS). This meta‐analysis of observational studies indicates that anti‐HCV‐positive patients on dialysis have an increased risk of either liver or cardiovascular disease‐related mortality compared with anti‐HCV‐negative patients. Further studies are in progress to understand better the link between HCV and cardiovascular risk among patients on maintenance dialysis.

Development of Novel Combination Therapies

“…The prevalence rate of HCV among patients undergoing hemodialysis within a U.S. hemodialysis network was reported as 7.8 percent (range: 5.5 to 9.8 percent) (Finelli, Miller, et al 2005), and it is estimated that more than 60,000 HCV-infected patients will require hemodialysis by 2020 (Butt, Wang, et al 2011). A significant relationship has been observed between HCV infection and increased mortality among patients on long-term dialysis (Fabrizi, Dixit, et al 2012).…”

Hepatitis C Virus Infection in Chronic Kidney Disease

“…24 Studies have consistently shown that HCV infection is associated with an increased mortality in patients with ESRD. [25][26][27][28][29] In a meta-analysis by Fabrizi et al, 26 the relative risk of mortality was 1.35 (95% confidence interval, 1.25 to 1.47) among HCV-infected patients with ESRD. Analysis of cause-specific death showed an increased burden of cardiovascular risk, supporting the concept that HCV is a systemic disease with important extrahepatic consequences.…”

“…Analysis of cause-specific death showed an increased burden of cardiovascular risk, supporting the concept that HCV is a systemic disease with important extrahepatic consequences. 26 Of interest, transplanting an anti-HCVpositive patient with ESRD is accompanied by a significantly decreased risk of death compared with remaining on the waiting list. This survival benefit is largely attributable to a decrease in cardiovascular events within the first year post-transplant.…”

“…30 Thus, although it is important to recognize that HCVinfected kidney recipients have an increased hazard ratio for death, transplant continues to offer these patients a significantly improved survival compared with remaining on dialysis. [25][26][27][28][29]31 HCV and KT HCV infection is the primary cause of liver disease in KT recipients 32 ; however, it has also been associated with important extrahepatic manifestations that contribute to increased morbidity and mortality after transplantation. 33 HCVinfected recipients are at increased risk of de novo and recurrent membranous nephropathy, membranoproliferative GN, [34][35][36] and transplant glomerulopathy.…”

Grazoprevir plus elbasvir and other treatment options in hepatitis C infected patients with stage 4–5 chronic kidney disease

“…Patients on maintenance hemodialysis with HCV continue to have higher mortality rates compared to those without HCV (3). Fortunately, the advent of well tolerated oral regimens for HCV has expanded the treatment strategies in patients with severe CKD and hemodialysis.…”