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Hepatitis C Virus and Death Risk in Hemodialysis Patients

Kamyar Kalantar-Zadeh^*,, Ryan D. Kilpatrick^*,, Charles J. McAllister, Loren G. Miller^||, Eric S. Daar^¶, David W. Gjertson, Joel D. Kopple^,** and Sander Greenland

^* Harold Simmons Center for Kidney Disease Research and Epidemiology, and Divisions of Nephrology and Hypertension, ^|| Infectious Disease, and ^¶ HIV Disease, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, and David Geffen School of Medicine at UCLA, Torrance, Departments of Epidemiology, Biostatistics, and ^** Community Health, School of Public Health, University of California Los Angeles, Los Angeles, and (8) DaVita, Inc., El Segundo, California

Address correspondence to: Dr. Kamyar Kalantar-Zadeh, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90509-2910. Phone: 310-222-3891; Fax: 310-782-1837; E-mail: kamkal{at}ucla.edu

Received for publication July 14, 2006. Accepted for publication March 1, 2007.

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.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673