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Abstract: FR-PO772

HCV in Hemodialysis Patients: Where Is the Difference?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Guinsburg, Adrian M., Fresenius Medical Care, Moron, Argentina
  • Ferder, Marcelo D., Fresenius Medical Care Argentina S.A., Buenos Aires, Argentina
Background

Several authors have described worst outcomes in HCV patients (pts) due to cardiovascular (CV) diseases, cirrhosis and hepatocarcinoma. Though, outcomes in HD pts are controversial. The aim of this study was to identify HCV+ pts characteristics affecting long term survival in HD.

Methods

Pts from Fresenius Medical Care Argentina database were included and classified as HCV+ when HCV antibodies were detected by ELISA and then followed until death, transplant or lost to follow-up. Differences in baseline labs were compared and all-cause, CV and liver mortality were analyzed using uni and multivariate Cox models.

Results

35,707 incident pts were included. Age 57.1±16.9 yrs, gender 57.7% male, DBT 16.5%, CVD 12%, neoplasia 1.1%. HCV+ prevalence 5.9% (2121). Mean follow-up time 3.45 ± 3.2 yrs CI [3.42 - 3.48].
HCV+ pts were younger (52.3 ± 15 vs 57.4± 17 yrs), had higher Hb (9.98 ± 2.1 vs 9.28 ± 1.9 mg%), higher ferritin (543 ± 646 vs 469 ± 521 ng/ml), higher Ca (8.94 ± 1.1 vs 8.59 ± 0.9 mg%), higher albumin (3.69 ± 0.5 vs 3.61 ± 0.6 g/dl), lower CRP (11.9 ± 21 vs 18.8 ± 36 mg/l), higher liver enzymes (AST 32.5 ± 28 vs 21.4 ± 24, ALT 34.6 ± 41 vs 22.2 ± 58, ALP 377.7 ± 438 vs 256 ± 236 IU/l) and lower total cholesterol (163.5 ± 44 vs 172.8 ± 51 mg%).
Surprisingly, unadjusted Cox models showed advantage in HCV+ for all-cause mortality (n=35,707, events 15,839 RR 0.87 p < 0.0001, CI [0.82-0.93]) and CV mortality (n=35,707, events 2,545 RR 0.31 p < 0.0001, CI [0.24-0.39]) but no difference for liver mortality.
After adjustment to case-mix, nutritional and inflammation markers, survival advantage disappears for all-cause (n=4,283, events 1,227 RR 1.17 pNS) and CV mortality (n=4,283, events 470 RR 1 pNS).

Conclusion

In our study HCV+ pts showed lower CRP and higher Hb levels, as well as lower all-cause and CV mortality.
Lower CRP levels were previously reported associated with disturbance in production of CRP[1]. Higher Hb levels were published related to increased production of EPO in the liver[2].
Even paradoxical unadjusted effect of HCV+ was reported[3], it's not in accordance with several studies and may be related to ameliorated inflammatory response. In fact, adjusting to inflammatory markers vanished this effect.
Prospective, controlled trials may be needed to identify HCV effect on HD patients
[1]Braz J Med Biol Res. 2005;38:783-8
[2]Blood Purif 2011;32:69–74 73
[3]J Bras Nefrol 2010;32(4): 335-339