Outcomes for hemodialysis patients with hepatitis C infection

Hepatitis C virus (HCV) infection is common among hemodialysis patients worldwide. Guidelines recommend treatment of all patients infected with hepatitis C, except those with life expectancy less than 12 months. However, in practice hepatitis C is rarely treated in hemodialysis patients. In a recent paper, investigators examined data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to evaluate the burden of hepatitis C infection among hemodialysis patients.

The authors found that hepatitis C infection among hemodialysis patients is associated with higher risk of death, hospitalization, and anemic complications, and with a variety of undesirable quality-of-life scores, including depression, anorexia, pruritus, greater pain, and worse vitality. Despite these adverse outcomes, in the current study only 1.5% of hemodialysis patients with hepatitis C received antiviral therapy. Treatment rates are much higher in the general population (22-28% in the United States and the United Kingdom).

Given these findings, the authors conclude that it appears erroneous to assume that hepatitis C infection among hemodialysis patients can be ignored because these patients won’t live long enough to develop undesirable consequences.

Lead author Dr. David Goodkin added, “Our study reaffirms that hepatitis C infection among patients on hemodialysis does not result in notable elevation of serum transaminase concentrations. For this reason, clinicians may not realize that their patients are suffering from severe liver damage and the patients are burdened by many consequences, including increased risk of death. Our data provide a rationale for treatment of greater numbers of patients.”

New and vastly improved medications for hepatitis C have become available in recent years. Yet in DOPPS prescription data from 2012 to the present, only 11 patients have been treated with these new drugs. In light of the availability of safe, effective therapy, it is uncertain why hemodialysis patients essentially remain untreated for hepatitis C.

CITATION:Goodkin DA, Bieber B, Jadoul M, Martin P, Kanda E, Pisoni RL. Mortality, hospitalization, and quality of life among patients with hepatitis C infection on hemodialysis. Clin J Am Soc Nephrol 2017;12(2):287-297.
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