The impact of Hepatitis C virus infection on mortality of patients receiving regular dialysis remains unclear.
The assessment of the natural history of Hepatitis C virus in dialysis population is difficult because of the low progression of Hepatitis C virus-related liver disease over time.
Assessments are also made difficult because of the reduced life expectancy in patients with end-stage renal disease.
Dr Fabrizio Fabrizi and colleagues from Italy conducted a systematic review of the published medical literature concerning the impact of Hepatitis C virus infection on the survival of patients undergoing maintenance dialysis.
|The summary estimate for adjusted relative risk was 1.3|
|Journal of Viral Hepatitis|
The relative risk of mortality was regarded as the most reliable outcome end-point.
Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates for mortality with Hepatitis C virus across the published studies.
The research team identified 7 studies involving 11,589 unique patients on maintenance dialysis, of which 2 were case-control studies.
Pooling of study results demonstrated that presence of anti-Hepatitis C virus antibody was an independent risk factor for death in maintenance dialysis.
The summary estimate for adjusted relative risk was 1.3.
The researchers undertook a sensitivity analysis including only 5 cohort studies, and found that the pooled adjusted relative risk was 1.4.
The team found as a cause of death, that hepatocellular carcinoma and liver cirrhosis were more frequent among anti-Hepatitis C virus-positive dialysis patients.
Dr Fabrizi's team concluded, "Our meta-analysis indicates that anti-Hepatitis 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."