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Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis
Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis
- Source :
- Clinical Journal of the American Society of Nephrology, Vol. 12, no.2, p. 287-297 (2017)
- Publication Year :
- 2016
-
Abstract
- Hepatitis C virus (HCV) infection is widely prevalent among patients on hemodialysis (HD), but very rarely treated. The aim of our study is to evaluate the burdens of HCV suffered by patients on HD.The Dialysis Outcomes and Practice Patterns Study is an international, prospective, cohort study of patients on HD. We reviewed the HCV status of 76,689 adults enrolled between 1996 and 2015. We compared HCV-positive (HCV+) with HCV-negative (HCV-) patients for risk of mortality, hospitalization, decline in hemoglobin concentration8.5 g/dl, and red blood cell transfusion. We also compared health-related quality of life scores using the Kidney Disease Quality of Life instrument and the Center for Epidemiologic Studies Short Depression Scale. We adjusted for age, sex, race, years on dialysis, 14 comorbid conditions (including hepatitis B infection), and serum albumin, phosphorus, and creatinine concentrations.A total of 7.5% of patients were HCV+ at enrollment. Serum concentrations of alanine aminotransferase and aspartate aminotransferase were not markedly elevated in HCV+ patients on HD; the mean concentrations were only 22.6 and 21.8 U/L, respectively. Median follow-up was 1.4 years. Case-mix adjusted hazard ratios (95% confidence intervals) for HCV+ versus HCV- patients were 1.12 (1.05 to 1.20) for all-cause mortality, 5.90 (3.67 to 9.50) for hepatic-related mortality, 1.09 (1.04 to 1.13) for all-cause hospitalization, and 4.40 (3.14 to 6.15) for hepatic-related hospitalization. Quality of life measures indicated significantly worse scores for physical function, pain, vitality, mental health, depression, pruritus, and anorexia among HCV+ patients. The adjusted hazard ratio for transfusion was 1.36 (95% CI, 1.20 to 1.55) and incidence of hemoglobin concentration8.5 g/dl was 1.12 (95% CI, 1.03 to 1.21). Only 1.5% of HCV+ patients received antiviral medication.HCV infection among patients on HD is associated with higher risk of death, hospitalization, and anemic complications, and worse quality of life scores. Internationally, HCV infection is almost never treated in patients on HD. Our data provide a rationale for more frequent treatment of HCV in this population.
- Subjects :
- Adult
Male
medicine.medical_specialty
Epidemiology
medicine.medical_treatment
Population
030232 urology & nephrology
Comorbidity
Critical Care and Intensive Care Medicine
Antiviral Agents
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Internal medicine
Cause of Death
medicine
Risk of mortality
Prevalence
Humans
Blood Transfusion
Aspartate Aminotransferases
Intensive care medicine
education
Cause of death
Aged
Transplantation
education.field_of_study
business.industry
Hazard ratio
virus diseases
Alanine Transaminase
Anemia
Hepatitis C
Original Articles
Hepatitis B
Middle Aged
medicine.disease
digestive system diseases
Hospitalization
Nephrology
Cardiovascular Diseases
Quality of Life
Kidney Failure, Chronic
030211 gastroenterology & hepatology
Female
Hemodialysis
business
Cohort study
Subjects
Details
- ISSN :
- 1555905X
- Volume :
- 12
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Accession number :
- edsair.doi.dedup.....b302e255527fbf68a531e181839f763f