Hepatitis C virus infection and dialysis: 2012 update

Area of Science:

• Nephrology
• Hepatology
• Infectious Diseases

Background:

• Hepatitis C virus (HCV) infection remains prevalent in dialysis patients, yet its long-term impact on survival is not fully understood.
• Anti-HCV positive serologic status is associated with increased liver and cardiovascular disease-related mortality in this population.

Purpose of the Study:

• To evaluate the mortality risks associated with HCV infection in dialysis patients.
• To assess the efficacy and outcomes of antiviral therapies for HCV in patients undergoing dialysis.

Main Methods:

• A meta-analysis of fourteen studies involving 145,608 unique patients was conducted to determine the adjusted relative risk (RR) for liver disease-related and cardiovascular mortality.
• A pooled analysis of 151 dialysis patients examined sustained viral response and dropout rates for combination antiviral therapy.

Main Results:

• The adjusted RR for liver disease-related death was 3.82 (95% CI, 1.92; 7.61) and for cardiovascular mortality was 1.26 (95% CI, 1.10; 1.45) in anti-HCV positive patients.
• Combination antiviral therapy (pegylated interferon plus ribavirin) demonstrated a 56% sustained viral response rate, with a 25% dropout rate.

Conclusions:

• HCV infection significantly increases mortality risk in dialysis patients, underscoring the need for careful treatment considerations.
• Modern antiviral therapies, such as pegylated interferon plus ribavirin, offer a viable treatment option with a notable sustained viral response rate.