Hepatitis C inflection in dialysis patients: a link to poor clinical outcome?

  • Kamyar Kalantar-Zadeh
  • Eric S. Daar
  • Viktor E. Eysselein
  • Loren G. Miller
Review Paper

DOI: 10.1007/s11255-006-9075-8

Cite this article as:
Kalantar-Zadeh, K., Daar, E.S., Eysselein, V.E. et al. Int Urol Nephrol (2007) 39: 247. doi:10.1007/s11255-006-9075-8

Abstract

Among the 350,000 maintenance dialysis patients in the USA, the mortality rate is high (20–23% per year) as is the prevalence of hepatitis C virus (HCV) infection (5–15%). An additional same number of dialysis patients in the USA may be infected with HCV but have undetectable HCV antibodies. Almost half of all deaths in dialysis patients, including HCV-infected patients, are due to cardiovascular disease. Since over two-thirds of dialysis patients die within 5 years of initiating dialysis and because markers of malnutrition–inflammation complex syndrome (MICS), rather than traditional cardiovascular risk factors, are among the strongest predictors of early death in these patients, the impact of HCV infection on nutritional status and inflammation may be a main cause of poor survival in this population. Based on data from our cross-sectional and limited longitudinal studies, we hypothesize that HCV infection confounds the association between MICS and clinical outcomes in dialysis patients and, by doing so, leads to higher short-term cardiovascular events and death. Understanding the natural history of HCV and its association with inflammation, nutrition and outcomes in dialysis patients may lead to testing more effective anti-HCV management strategies in this and other similar patient populations, providing benefits not only for HCV infection but the detrimental consequences associated with this infection. In this article, we review the link between the HCV infection and mortality in dialysis patients and compare HCV antibody to molecular methods to detect HCV infection in these individuals.

Keywords

Hepatitis C Dialysis Cardiovascular death Malnutrition–inflammation complex syndrome Transcription mediated amplification 

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Kamyar Kalantar-Zadeh
    • 1
  • Eric S. Daar
    • 2
  • Viktor E. Eysselein
    • 3
  • Loren G. Miller
    • 4
  1. 1.Division of Nephrology and HypertensionLos Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  2. 2.Division of HIV MedicineLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLATorranceUSA
  3. 3.Division of GastroenetrologyLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLATorranceUSA
  4. 4.Division of Infectious DiseaseLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLATorranceUSA

Personalised recommendations