Hepatitis C infection is very rarely treated among hemodialysis patients

Am J Nephrol. 2013;38(5):405-12. doi: 10.1159/000355615. Epub 2013 Oct 29.

Abstract

Background: Hepatitis C virus (HCV) infection is associated with increased mortality among hemodialysis (HD) patients. Guidelines from Kidney Disease: Improving Global Outcomes recommend that infected HD patients awaiting renal transplantation be treated for HCV and that clinicians decide whether to treat other infected patients on a case-by-case basis. We evaluated the extent and outcome of HCV therapy among HD patients.

Methods: The Dialysis Outcomes and Practice Patterns Study is an observational study; 49,762 HD patients in 12 nations enrolled between 1996 and 2011. We reviewed HCV status, use of interferon or ribavirin, and survival over a median 1.4 years per study phase.

Results: 4,735 patients (9.5%) were HCV+. Only 48 (1.0%) of the 4,589 HCV+ patients with prescription data were receiving antiviral medication. Among the subset of 617 HCV+ patients also known to be on a waiting list for renal transplantation, only 3.7% were receiving treatment. After restricting to HCV+ patients with overlapping propensity for antiviral treatment, 4 (9.5%) of 42 treated patients and 638 (21.0%) of 3,037 untreated patients died. The hazard ratio for adjusted mortality comparing treated patients with untreated patients was 0.47 (95% CI, 0.17-1.26).

Conclusions: HD patients with hepatitis C infection very rarely receive antiviral therapy. Increased intervention might prolong survival for some patients and in particular might improve the prospects for those awaiting renal transplantation.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Female
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / immunology
  • Humans
  • Interferons / therapeutic use
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Prevalence
  • Proportional Hazards Models
  • Renal Dialysis / methods*
  • Ribavirin / therapeutic use
  • Time Factors
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Ribavirin
  • Interferons