Abstract
In maintenance hemodialysis (MHD) patients, hepatitis C virus (HCV) infection is common and may be associated with poor clinical outcomes. It was hypothesized that HCV infection would be associated with high all-cause and cardiovascular mortality in these patients after controlling for demographic and clinical characteristics, including surrogates of malnutrition-inflammation complex syndrome. A national database of 13,664 MHD patients who underwent HCV antibody serology testing at least once during a 3-yr interval (July 2001 through June 2004) was analyzed. Measurements included third-generation HCV enzyme immunoassay and routine laboratory measurements. The HCV enzyme immunoassay was reported positive in 1590 (12%) patients. In logistic regression models that included case mix and available surrogates of malnutrition-inflammation complex syndrome, HCV infection was associated with younger age, male gender, black race, Hispanic ethnicity, Medicaid insurance, longer dialysis vintage (duration), unmarried status, HIV infection, and smoking history. In proportional-hazards regressions, the mortality hazard ratio that was associated with HCV infection was 1.25 (95% confidence interval 1.12 to 1.39; P < 0.001). Mortality hazards were higher among incident (dialysis duration <6 mo) than prevalent HD patients. Subgroup analyses indicated that HCV was associated with higher all-cause and cardiovascular mortality across almost all clinical, demographic, and laboratory groups of patients. Hence, in MHD patients, HCV infection exhibits distinct demographic, clinical, and laboratory patterns, including associations with higher dialysis treatment vintage, and is associated with higher mortality. More diligent efforts to prevent and treat HCV infection may improve outcomes in MHD patients.
Highlights
Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in the world (1)
Because hepatitis C virus (HCV) infection is associated with increases in inflammatory markers and alterations in nutritional status in both the general population (17–19) and dialysis patients (20) and is related to poor survival in maintenance hemodialysis (MHD) patients, examining associations between HCV infection and death risk after adjustment for markers of malnutrition-inflammation complex (or cachexia) syndrome (MICS) may better reveal the mechanisms that lead to mortality that is associated with HCV infection
We examined only HCV enzyme immunoassay (EIA) tests that were performed in the DaVita Laboratory after a patient was admitted for MHD Journal of the American Society of Nephrology and only patients who remained under MHD treatment for at least 45 d
Summary
Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in the world (1). Certain populations, including maintenance hemodialysis (MHD) patients, have a significantly higher prevalence of HCV infection, ranging from 5 to 25% or even higher, according to the recent literature (2–5) This population may serve as an exceptional model to study the impact of HCV infection on outcomes, especially because the short-term death risk is extremely high in MHD patients in the United States, at least 20% annually (6). Given that HCV-associated liver disease typically takes decades to become clinically manifest, a period of time much longer than the lifespan of most dialysis patients with a 5-yr survival. Parts of these data were supplied by the USRDS, and the findings do not necessarily represent the opinion of the US government or the USRDS. We examined whether HCVinfected MHD patients have distinct demographic, clinical, and laboratory characteristics that can be used to screen for HCV infection
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