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Meta-analysis: effect of hepatitis C virus infection on mortality in dialysis

  1. F. Fabrizi1,2,
  2. P. Martin1,3,
  3. V. Dixit3,
  4. S. Bunnapradist3,
  5. G. Dulai4

Article first published online: 6 DEC 2004

DOI: 10.1111/j.1365-2036.2004.02290.x

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 20, Issue 11-12, pages 1271–1277, December 2004

Additional Information

How to Cite

Fabrizi, F., Martin, P., Dixit, V., Bunnapradist, S. and Dulai, G. (2004), Meta-analysis: effect of hepatitis C virus infection on mortality in dialysis. Alimentary Pharmacology & Therapeutics, 20: 1271–1277. doi: 10.1111/j.1365-2036.2004.02290.x

Author Information

  1. 1

    Center for Liver and Kidney Diseases and Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA, USA

  2. 2

    Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milano, Italy

  3. 3

    Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA

  4. 4

    GLAVA Healthcare System, Los Angeles, CA, USA

*Dr F. Fabrizi, Divisione di Nefrologia, e Dialisi, Ospedale Maggiore, IRCCS, Pad. Croff, via Commenda, 15, Milano 20122, Italy. E-mail: fabrizi@policlinico.mi.it

Publication History

  1. Issue published online: 6 DEC 2004
  2. Article first published online: 6 DEC 2004
  3. Accepted for publication 24 September 2004

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Summary

Background : The natural history of hepatitis C virus infection among patients on long-term dialysis treatment remains incompletely understood. Efforts to elucidate the natural history of hepatitis C virus in this population are difficult because of the slowly progressive nature of hepatitis C virus with often an unrecognized onset in patients whose life-expectancy is substantially diminished by end-stage renal disease.

Aim : To conduct a systematic review of the published medical literature concerning the impact of hepatitis C virus infection on the survival of patients receiving chronic dialysis. The relative risk of mortality was regarded as the most reliable outcome end-point.

Methods : We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for mortality with hepatitis C virus across the published studies.

Results : We identified four clinical trials (2341 unique patients); three (75%) of them were prospective, cohort studies; the fourth was a case–control study. Pooling of study results demonstrated that presence of antihepatitis C virus antibody was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for relative risk was 1.57 with a 95% confidence interval (CI) of 1.33–1.86. A test for homogeneity of the relative risks across the four studies gave a P-value of 0.77. As a cause of death, hepatocellular carcinoma and liver cirrhosis were significantly more frequent among antihepatitis C virus-positive than -negative dialysis patients.

Conclusions : This meta-analysis demonstrates that antihepatitis C virus-positive patients on dialysis have an increased risk of mortality compared with hepatitis C virus-negative patients. The excess risk of death in hepatitis C virus-positive patients may be at least partially attributed to chronic liver disease with its attendant complications. Clinical trials with extended follow-up are currently under way to assess the effect of hepatitis C virus treatment on the excess risk of mortality in this population.

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