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J Am Soc Nephrol 11:1896-1902, 2000
© 2000 American Society of Nephrology

Prognosis of Anti-Hepatitis C Virus Antibody-Positive Patients on Regular Hemodialysis Therapy

EIJUN NAKAYAMA*, TAKASHI AKIBA{dagger}, FUMIAKI MARUMO{ddagger} and CHIFUMI SATO*

* Department of Health Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
{dagger} Department of Blood Purification, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
{ddagger} Second Department of Internal Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.

Correspondence to Dr. Chifumi Sato, Department of Health Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Phone: 81-3-5803-5335; Fax: 81-3-5803-0152; E-mail: c.sato.ns{at}tmd.ac.jp

Abstract. The prevalence of hepatitis C virus (HCV) infection is high in patients who are on chronic hemodialysis, but the role of HCV infection and HCV-related liver disease in the mortality of these patients has not been shown. Therefore, we conducted a prospective cohort study of 1470 patients who were on chronic hemodialysis (17 to 89 yr old) from 16 dialysis centers in Japan. Among them, 276 patients (18.8%) were positive for anti-HCV antibodies and 1194 patients were negative. The patients were followed for 6 yr from 1993 to 1999. Only one case, a patient from the anti-HCV-antibody-positive group, was lost to the follow-up during this period. The mortality was higher in the anti-HCV-antibody-positive group (91 of 276 patients died) than in the anti-HCV-antibody-negative group (277 of 1193 died) (33.0% versus 23.2%, P < 0.01). A Cox proportional hazard examination showed that positivity for anti-HCV antibodies was one of the risk factors for death with an adjusted relative risk of 1.57 (95% confidence interval, 1.23 to 2.00). As a cause of death, hepatocellular carcinoma and liver cirrhosis were significantly more frequent in the anti-HCV-antibody-positive patients than in the anti-HCV-antibody-negative patients (5.5% versus 0.0%, P < 0.001; 8.8% versus 0.4%, P < 0.001, respectively). These findings show that the mortality is increased in anti-HCV-antibody-positive patients who are on chronic hemodialysis. Hepatocellular carcinoma and liver cirrhosis are factors that may influence the mortality.




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