Hepatitis B and C in peritoneal dialysis patients

Mortality in Hepatitis C-Positive Patients Treated with Peritoneal Dialysis

Objective

The published mortality data for patients with hepatitis C virus (HCV) infection and being treated with peritoneal dialysis (PD) are not available. The aim of this study was to determine the mortality of HCV patients undergoing PD.

Methods

We retrospectively reviewed 538 PD patients in our hospital from 1996 to 2005. Of these patients, 75 (13.9%) were anti-HCV positive at the beginning of PD. We used Kaplan–Meier analysis to compare mortality between patients with and patients without HCV infection. The association between HCV infection and mortality was analyzed using multivariate Cox regression with adjustment for age, gender, residual renal function, and cardiovascular disease.

Results

A total of 157 patients (39 HCV positive, 118 HCV negative) died during the 10-year follow-up period. The mortality rate (52%, 39/75) of HCV-positive patients was significantly higher than that of HCV-negative patients (25.5%, 118/463; p < 0.001). Cardiovascular mortality was 57.6% (68/118) among HCV-negative patients and 56.4% (22/39) among HCV-positive patients. Kaplan–Meier estimate showed that patients with HCV infection had higher mortality than those without ( p < 0.001, log-rank). The result of Cox regression suggested that chronic HCV infection, independent of diabetes, was associated with 10-year mortality. The adjusted hazard ratios (HRs) of HCV infection and diabetes for mortality were 2.195 (95% CI: 1.486 – 3.243, p < 0.001) and 2.242 (95% CI: 1.533 – 3.277, p < 0.001).

Conclusion

Our results show that the HCV-positive PD patients had a higher 10-year mortality rate than the HCV-negative PD patients. The association between HCV infection and mortality was independent of diabetes. Cardiovascular mortality, infection, and arrhythmia were the leading causes of death among the PD patients with HCV infection.

Differential Effect of Viral Hepatitis Infection on Mortality among Korean Maintenance Dialysis Patients: A Prospective Multicenter Cohort Study

The role of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in terms of survival among dialysis patients remains incompletely understood. In the present multicenter prospective cohort study, we investigated the prevalences of HBV and HCV infection among 3,321 patients receiving maintenance dialysis in Korea, and assessed the impacts of these infections on survival. All included patients underwent hepatitis B antigen (HBsAg) and HCV antibody (Ab) testing, which revealed that 236 patients (7.1%) were HBsAg-positive, and 123 patients (3.7%) were HCV Ab-positive. HBsAg-positive and HCV Ab-positive patients were matched to hepatitis virus-negative patients using a propensity score at a ratio of 1:2. The prevalences of HBV and HCV infection did not significantly differ according to dialysis modality. Linear-by-linear association analysis revealed that hepatitis B prevalence significantly increased with increasing dialysis vintage (p = 0.001), and hepatitis C prevalence tended to be higher with increasing dialysis vintage (p = 0.074). We compared the survival of HBsAg-positive and HCV Ab-positive patients to that of hepatitis virus-negative patients. After propensity score matching, cumulative survival did not differ between HBsAg-positive and HBsAg-negative patients (p = 0.37), while HCV Ab-positive patients showed significantly lower survival than HCV Ab-negative patients (p = 0.03). The main conclusions of the present study are that HBV infection prevalence increased with longer dialysis vintage, and that both HBV and HCV infections were most prevalent among patients with the longest dialysis vintage. Additionally, HCV infection among maintenance dialysis patients is associated with an increased risk of mortality.

Review article: Hepatitis B and dialysis

The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy.

Comparing Survival between Peritoneal Dialysis and Hemodialysis Treatment in Esrd Patients with Chronic Hepatitis C Infection

Objective

End-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection are associated with an increasing mortality risk on hemodialysis (HD) and peritoneal dialysis (PD). The aim of this study was to compare patient survival between HCV-positive patients undergoing PD versus HD.

Methods

We reviewed 78 PD and 78 HD patients with chronic hepatitis C infection in China Medical University Hospital from 1996 to 2006. The HD patients were selected using the propensity score matching method. Kaplan–Meier analysis with log-rank test was used to compare patient survival between patients treated with PD and those treated with HD. Possible prognostic factors were analyzed using multivariate Cox proportional hazard regression with adjustments for age, sex, and propensity score.

Results

Mortality rate was 50% (39/78) for PD and 41% (32/78) for HD (chi-square test p = 0.26). Diabetes, hypertension, and cardiovascular disease were present in 43.6%, 25.6%, and 14.1% of patients, respectively. Kaplan–Meier estimate and univariate Cox regression with adjustments for age and propensity score showed that HCV patients treated with PD had a similar survival to those treated with HD ( p = 0.381 and p = 0.363). In forward stepwise Cox regression, positivity for hepatitis B virus surface antigen ( p < 0.001), diabetes ( p = 0.009), and serum albumin ( p = 0.032) were independently associated with higher mortality.

Conclusion

Patient survival is not different between ESRD patients with chronic hepatitis C treated with PD and those treated with HD. In ESRD patients positive for HCV, being positive for hepatitis B virus is an important prognostic factor.

Distribution of HCV genotypes in patients with end-stage renal disease according to type of dialysis treatment

The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.

Hepatitis intensified oxidative stress, MIP-1beta and RANTES plasma levels in uraemic patients

HBV and HCV infections are associated with the increased production of reactive oxygen species (ROS) within the liver that are responsible for the oxidation of intracellular molecules and activation transcription factors. The aim of the present study was to establish whether the presence of hepatitis could be implicated in the elevation of oxidative stress (SOX) and plasma proinflammatory and chemoattractant cytokine levels in uraemic patients. The markers of SOX-autoantibodies to oxidized LDL (OxLDL-Ab); total peroxides; and the major antioxidant enzyme Cu/Zn superoxide dismutase (Cu/Zn SOD); as well as tumor necrosis factor-alpha (TNF-alpha); regulated upon activation, normal T cell expressed and secreted (RANTES); and macrophage inflammatory protein-1alpha (MIP-1alpha) and beta (MIP-1beta) levels were measured in the plasma of uraemic patients with hepatitis in comparison to subjects without hepatitis and to healthy volunteers. The values of total peroxide, Cu/Zn SOD, TNF-alpha, and MIP-1beta, were significantly elevated in uraemic patients when compared to the controls, whereas RANTES were decreased. MIP-1alpha and OxLDL-Ab were similar in the two groups. Cu/Zn SOD, MIP-1beta and RANTES concentrations were significantly higher in the hepatitis-positive relative to the hepatitis-negative group. Both MIP-1beta and RANTES were directly associated with Cu/Zn SOD levels and the presence of hepatitis. Multiple stepwise regression analysis has shown that the duration of dialysis, followed by the presence of hepatitis, independently and significantly predicted increased Cu/Zn SOD levels, whereas elevated Cu/Zn SOD as an independent variable was significantly associated with both increased both MIP-1beta and RANTES in uraemic patients. These results suggest that the presence of viral hepatitis status and liver injury are novel determinants of increased oxidative stress, as well as of increased MIP-1beta and RANTES levels in uraemic patients.