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Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis
David A Goodkin1, Brian Bieber1, Michel Jadoul2
1Arbor Research Collaborative for Health, Ann Arbor, Michigan.
Insights
Hepatitis C virus (HCV) infection in hemodialysis patients significantly increases mortality and hospitalization risks. Despite these burdens, HCV is rarely treated in this population, highlighting a need for increased intervention.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection is common in hemodialysis (HD) patients.
- Treatment for HCV in HD patients is infrequent.
Purpose of the Study:
- To evaluate the clinical burdens associated with HCV infection in patients undergoing hemodialysis.
- To assess the impact of HCV on mortality, hospitalization, anemia, and quality of life in HD patients.
Main Methods:
- Analysis of a large international prospective cohort study (Dialysis Outcomes and Practice Patterns Study) of 76,689 adult HD patients from 1996-2015.
- Comparison of HCV-positive (HCV+) versus HCV-negative (HCV-) patients regarding mortality, hospitalization, hemoglobin levels, red blood cell transfusions, and quality of life.
- Statistical adjustment for multiple confounding factors including age, sex, comorbidities, and laboratory values.
Main Results:
- 7.5% of HD patients were HCV+; only 1.5% received antiviral treatment.
- HCV+ patients had significantly higher risks for all-cause mortality (HR 1.12) and hepatic-related mortality (HR 5.90).
- HCV+ patients experienced increased hospitalization (all-cause HR 1.09, hepatic-related HR 4.40), anemia complications, transfusion needs, and worse quality of life scores.
Conclusions:
- HCV infection poses substantial risks for hemodialysis patients, including increased mortality, hospitalization, and diminished quality of life.
- The under-treatment of HCV in this vulnerable population is evident, with less than 2% receiving antiviral therapy.
- These findings strongly support the need for increased screening and treatment of HCV in patients on hemodialysis.
Background And Objectives:
Hepatitis C virus (HCV) infection is widely prevalent among patients on hemodialysis (HD), but very rarely treated. The aim of our study is to evaluate the burdens of HCV suffered by patients on HD.
Design, Setting, Participants, & Measurements:
The Dialysis Outcomes and Practice Patterns Study is an international, prospective, cohort study of patients on HD. We reviewed the HCV status of 76,689 adults enrolled between 1996 and 2015. We compared HCV-positive (HCV+) with HCV-negative (HCV-) patients for risk of mortality, hospitalization, decline in hemoglobin concentration <8.5 g/dl, and red blood cell transfusion. We also compared health-related quality of life scores using the Kidney Disease Quality of Life instrument and the Center for Epidemiologic Studies Short Depression Scale. We adjusted for age, sex, race, years on dialysis, 14 comorbid conditions (including hepatitis B infection), and serum albumin, phosphorus, and creatinine concentrations.
Results:
A total of 7.5% of patients were HCV+ at enrollment. Serum concentrations of alanine aminotransferase and aspartate aminotransferase were not markedly elevated in HCV+ patients on HD; the mean concentrations were only 22.6 and 21.8 U/L, respectively. Median follow-up was 1.4 years. Case-mix adjusted hazard ratios (95% confidence intervals) for HCV+ versus HCV- patients were 1.12 (1.05 to 1.20) for all-cause mortality, 5.90 (3.67 to 9.50) for hepatic-related mortality, 1.09 (1.04 to 1.13) for all-cause hospitalization, and 4.40 (3.14 to 6.15) for hepatic-related hospitalization. Quality of life measures indicated significantly worse scores for physical function, pain, vitality, mental health, depression, pruritus, and anorexia among HCV+ patients. The adjusted hazard ratio for transfusion was 1.36 (95% CI, 1.20 to 1.55) and incidence of hemoglobin concentration <8.5 g/dl was 1.12 (95% CI, 1.03 to 1.21). Only 1.5% of HCV+ patients received antiviral medication.
Conclusions:
HCV infection among patients on HD is associated with higher risk of death, hospitalization, and anemic complications, and worse quality of life scores. Internationally, HCV infection is almost never treated in patients on HD. Our data provide a rationale for more frequent treatment of HCV in this population.
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