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HCV treatment during hemodialysis for kidney disease improves survival

A recently published study showed that patients with chronic hepatitis C have an increased risk for chronic kidney disease. Additionally, HCV treatment appeared to improve survival among patients with chronic HCV and patients on hemodialysis compared with untreated patients.

“The treatment of patients with CHC infection on hemodialysis (HD) using interferon (IFN)-alpha with or without ribavirin (RBV) has been cumbersome due to an increased risk of adverse events and a lack of expertise in treating this special population,” Jonas Söderholm, from the Karolinska University Hospital Huddinge, Sweden, and colleagues wrote. “More attention should be paid to the potential benefit of HCV treatment in the CKD population, which may in the long term reduce the need for dialysis and kidney transplantation.”

From 2001 to 2013, the investigators identified 45,222 patients diagnosed with chronic HCV from nationwide registries in Sweden and matched 202,694 general population individuals five-to-one with each patient.

Overall, 1,077 patients with chronic HCV were diagnosed with CKD over 280,123 person-years (3.84 cases per 1,000 person-years), vs. 1,454 individuals in the matched population over 1,504,765 person-years (0.97 cases per 1,000 person-years). This resulted in a standardized incidence ratio of 4 (95% CI, 3.7–4.2).

During the study, mortality rates were 19% among the chronic HCV cohort and 4% among the match population for a standardized mortality rate of 5.6, and 52% among patients with CKD for a standardized mortality rate of 6.9.

The most common causes of death among patients with chronic HCV and CKD included chronic HCV, acute myocardial infarction, CKD, unspecific kidney failure and diabetes with renal complications. The most common causes of death among the matched population were diseases of the circulatory system.

Forty-five of the 268 patients with chronic HCV who required hemodialysis received interferon-based HCV treatment, 27 of whom received HCV treatment after hemodialysis initiation. Compared with untreated patients, significantly fewer patients on hemodialysis and HCV therapy died during the study period (24% vs. 56%; P = .001). However, treatment before or after hemodialysis did not impact survival.

Factors associated with survival among patients with chronic HCV who required hemodialysis included younger age at hemodialysis initiation (OR = 0.965; 95% CI, 0.942-0.989), kidney transplantation (OR = 2.72; 95% CI, 1.472-5.026), HCV treatment (OR = 3.901; 95% CI, 1.72-8.85), and acute kidney failure diagnosis (OR = 2.611; 95% CI, 1.412-4.829).

After adjusting for age, kidney transplantation and acute kidney disease, the increased mortality risk for untreated patients with HCV while on hemodialysis remained significant (HR = 2.874; 95% CI, 5.358). – by Talitha Bennett

Disclosure: Söderholm reports he is an employee of AbbVie and may hold stocks or stock options. Please see the full study for the other authors’ relevant financial disclosures.