Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease

Abstract

The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated.The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged <20 years and those with a history of hepatitis B, kidney transplantation, or cancer were excluded. The control cohort included ESRD patients without HCV infection matched 4:1 to the HCV cohort by age, sex, and year of ESRD registration. We followed up all study participants until kidney transplantation, death, or the end of 2011, whichever came first. We assessed risk of all-cause mortality by using the multivariate Cox proportional hazard model with time-dependent covariate.In the HCV cohort, 134 patients (6.01%) received interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22–0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24–5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04–0.68) compared with that in the control cohort.For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma.

Direct medical costs associated with the extrahepatic manifestations of hepatitis C infection in Europe

“…Achieving SVR can also lessen the clinical burden of EHMs. Retrospective and prospective studies in several countries have shown that the achievement of SVR may protect against the development of mixed cryoglobulinemia, malignant lymphoma, end‐stage renal disease (ESRD) and type 2 diabetes . Clinical guidelines in Europe, therefore, recommend that HCV patients with clinically significant EHMs be prioritized for DAA treatment .…”

Rationale for treatment of hepatitis C virus infection in end‐stage renal disease patients who are not kidney transplant candidates

“…Of nearly 50,000 HD patients included in the Dialysis Outcomes and Practice Patterns (DOPPS) study, 9.5% were HCV seropositive, but only 1% of the almost 4500 patients with prescription data and 3.7% of patients on the kidney transplant waiting list had received anti‐HCV therapy during the interferon era . These low rates of HCV treatment may have been related to the unsatisfactory safety profile of interferon and ribavirin treatment regimens, an anticipated low sustained virological response (SVR) rates in the ESRD population, or to an expected lack of clinical benefit of HCV cure in dialysis patients. It is unknown whether this has changed in the current era of the highly effective direct‐acting antiviral (DAA) agents with low treatment‐associated adverse event rates.…”

“…To date, some studies have demonstrated that dialysis patients who received antiviral treatment have significant improvements in survival, particularly patients without cirrhosis or hepatocellular carcinoma . The reduction in the risk of mortality in treated patients could potentially be sustained over 3 years The International Dialysis Outcomes and Practice Patterns Survey (DOPPS) enrolling 49,762 patients receiving HD between 1996 and 2011, showed that with antiviral treatment for HCV, the hazard ratio for adjusted all‐cause mortality was lower in treated compared with non‐treated patients, though not reaching statistical significance (0.47; 95% CI 0.17–1.26) . Another study showed that IFN‐treated HCV cohort with no cirrhosis or hepatoma have markedly reduced risk of death in the compared with that in the control cohort (hazard ratio 0.17, 95% CI 0.04–0.68) .…”

“…The reduction in the risk of mortality in treated patients could potentially be sustained over 3 years The International Dialysis Outcomes and Practice Patterns Survey (DOPPS) enrolling 49,762 patients receiving HD between 1996 and 2011, showed that with antiviral treatment for HCV, the hazard ratio for adjusted all‐cause mortality was lower in treated compared with non‐treated patients, though not reaching statistical significance (0.47; 95% CI 0.17–1.26) . Another study showed that IFN‐treated HCV cohort with no cirrhosis or hepatoma have markedly reduced risk of death in the compared with that in the control cohort (hazard ratio 0.17, 95% CI 0.04–0.68) . Several studies in patients infected with HCV have found a significant reduction in the risk of acute coronary syndrome, and cerebrovascular events among those who underwent IFN‐based antiviral therapy compared to those who did not receive treatment .…”

Daclatasvir and reduced‐dose sofosbuvir: An effective and pangenotypic treatment for hepatitis C in patients with estimated glomerular filtration rate <30 mL/min

“…In view of this risk of adverse outcomes, the widely accepted and practised ‘Kidney Disease: Improving Global Outcomes’ (KDIGO) Guidelines recommend treatment for all patients with CKD and HCV infection . Successful treatment of HCV infection in such patients has been shown to improve clinical outcomes …”