title: Hepatitis C infection is very rarely treated among hemodialysis patients.
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.
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Mich., USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Goodkin
authors.forename: Brian
authors.initials: B
authors.lastname: Bieber
authors.forename: Brenda
authors.initials: B
authors.lastname: Gillespie
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Michel
authors.initials: M
authors.lastname: Jadoul
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000276:immunology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D012254:Ribavirin / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons