Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy.
The prevalence of hepatitis C virus (HCV) infection is high in patients who are on chronic hemodialysis, but the role of HCV infection and HCV-related liver disease in the mortality of these patients has not been shown. Therefore, we conducted a prospective cohort study of 1470 patients who were on chronic hemodialysis (17 to 89 yr old) from 16 dialysis centers in Japan. Among them, 276 patients (18.8%) were positive for anti-HCV antibodies and 1194 patients were negative. The patients were followed for 6 yr from 1993 to 1999. Only one case, a patient from the anti-HCV-antibody-positive group, was lost to the follow-up during this period. The mortality was higher in the anti-HCV-antibody-positive group (91 of 276 patients died) than in the anti-HCV-antibody-negative group (277 of 1193 died) (33.0% versus 23.2%, P< 0.01). A Cox proportional hazard examination showed that positivity for anti-HCV antibodies was one of the risk factors for death with an adjusted relative risk of 1.57 (95% confidence interval, 1.23 to 2.00). As a cause of death, hepatocellular carcinoma and liver cirrhosis were significantly more frequent in the anti-HCV-antibody-positive patients than in the anti-HCV-antibody-negative patients (5.5% versus 0.0%, P< 0.001; 8.8% versus 0.4%, P< 0.001, respectively). These findings show that the mortality is increased in anti-HCV-antibody-positive patients who are on chronic hemodialysis. Hepatocellular carcinoma and liver cirrhosis are factors that may influence the mortality.
Nakayama
Eijun
E
Department of Health Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Akiba
Takashi
T
Department of Blood Purification, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Marumo
Fumiaki
F
Second Department of Internal Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Sato
Chifumi
C
Department of Health Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D018937:Hepatitis C Antibodies / Q000032:analysis*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors
D018937:Hepatitis C Antibodies