Hepatitis C virus and mortality among patients on dialysis: A systematic review and meta-analysis - 18/06/19
, Vivek Dixit b, Piergiorgio Messa a, cBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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Highlights |
• | It is well known that HCV plays a detrimental role on survival among patients with intact kidneys. |
• | The current meta-analysis supports the notion that HCV increases the all-cause and stratified mortality among patients undergoing maintenance dialysis. |
• | The reduced survival reported among HCV-infected patients on maintenance dialysis is related not only to chronic liver disease and its attendant complications (cirrhosis and hepatocellular carcinoma) but also to cardiovascular risk. |
• | The mechanisms underlying the relationship between HCV and increased cardiovascular risk remain unclear and are still an area of ongoing research. |
• | It has been suggested that HCV accelerates atherosclerotic disease at renal level and interferes with hepatic or peripheral resistance to insulin, among others. |
• | Studies are in progress to assess whether the advent of antiviral therapy for HCV by DAAs (direct-acting antiviral agents) will translate into improved survival even among patients on maintenance dialysis. |
Summary |
Background and rationale |
The role of hepatitis C virus (HCV) as an independent risk factor for death in dialysis population is unclear.
Design |
A systematic review of the published medical literature was performed to evaluate the impact of positive anti-HCV serologic status on all-cause and disease-specific mortality in patients on regular dialysis. The risk of all-cause, cardiovascular and liver disease-related 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 HCV across the published studies.
Results |
Twenty-three observational studies (n = 574,081 patients on long-term dialysis) were identified. Pooling of study results demonstrated that HCV positive status was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for adjusted death risk (all-cause mortality) with HCV was 1.26 (95% CI: 1.18; 1.34) (P < 0.0001). Between-study heterogeneity was found (Q value 52.8, P = 0.001). The overall estimate for adjusted death risk (liver disease-related mortality) was 5.05 (95% CI: 2.53; 10.0) (P < 0.0001); heterogeneity statistics, Q value 8.2, P = 0.04. The overall estimate for adjusted death risk (cardiovascular mortality) was 1.18 (95% CI: 1.085; 1.29) (P < 0.0001) (no heterogeneity). Meta-regression showed that the effect of HCV on all-cause mortality was more evident in those studies provided with a greater size (P = 0.0001), a higher prevalence of diabetics (P = 0.0005) and HCV-infected individuals (P = 0.001).
Conclusions |
An association between HCV positive serologic status and increased risk of either liver or cardiovascular disease-related mortality exists among dialysis patients.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Hepatitis C, Cardiovascular diseases, Meta-analysis, Mortality, Renal dialysis
Abbreviations : ACE, AIDS-OI, ALT, AST, BMI, CI, CKD, CV, CVs, DOPPS, DAAs, DM, GI, HBV, HCV, HAART, HCC, HD, HIV, aHR, ICD-9-CM, NA, NOS, aOR, PCR, nPCR, nPNA, PD, PRISMA, PVD, RCT, rHuEPO, aRR, RT, URR, TIBC, TPN
Mappa
Vol 43 - N° 3
P. 244-254 - Giugno 2019 Ritorno al numero
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