Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy

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. There fore, 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. A mong them, 276 patients (18.8%) were positive for anti-HCV antibodies and 1 194 patients were negative. The patients were followed for 6 yr from 1993 t o 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 a nti-HCV antibodies was one of the risk factors for death with an adjusted r elative risk of 1.57 (95% confidence interval, 1.23 to 2.00). As a cause of death, hepatocellular carcinoma and liver cirrhosis were significantly mor e 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 increas ed in anti-HCV-antibody-positive patients who are on chronic hemodialysis. Hepatocellular carcinoma and liver cirrhosis are Factors that may influence the mortality.