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

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Abstract
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 aP‐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.