Hepatitis C virus infection and dialysis: 2012 update.

ISRN nephrology Pub Date : 2012-12-17 eCollection Date: 2013-01-01 DOI:10.5402/2013/159760
Fabrizio Fabrizi
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引用次数: 40

Abstract

Hepatitis C virus infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. Recent evidence has been accumulated showing that anti-HCV positive serologic status is significantly associated with lower survival in dialysis population; an increased risk of liver and cardiovascular disease-related mortality compared with anti-HCV negative subjects has been found. According to a novel meta-analysis (fourteen studies including 145,608 unique patients), the adjusted RR for liver disease-related death and cardiovascular mortality was 3.82 (95% CI, 1.92; 7.61) and 1.26 (95% CI, 1.10; 1.45), respectively. It has been suggested that the decision to treat HCV in patients with chronic kidney disease be based on the potential benefits and risks of therapy, including life expectancy, candidacy for kidney transplant, and co-morbidities. According to recent guidelines, the antiviral treatment of choice in HCV-infected patients on dialysis is mono-therapy but fresh data suggest the use of modern antiviral approaches (i.e., pegylated interferon plus ribavirin). The summary estimate for sustained viral response and drop-out rate was 56% (95% CI, 28-84) and 25% (95% CI, 10-40) in a pooled analysis including 151 dialysis patients on combination antiviral therapy (conventional or pegylated interferon plus ribavirin).

丙型肝炎病毒感染和透析:2012年更新。
丙型肝炎病毒感染在透析患者中仍然很常见,但该组丙型肝炎病毒的自然史尚不完全清楚。最近积累的证据表明,抗hcv血清学阳性状态与透析人群的低生存率显著相关;与抗hcv阴性受试者相比,肝脏和心血管疾病相关死亡风险增加。根据一项新的荟萃分析(14项研究,包括145,608名独特的患者),肝脏疾病相关死亡和心血管疾病死亡率的调整RR为3.82 (95% CI, 1.92;7.61)和1.26 (95% CI, 1.10;分别为1.45)。有研究表明,慢性肾脏疾病患者是否接受HCV治疗的决定应基于治疗的潜在获益和风险,包括预期寿命、肾移植候选资格和合并症。根据最近的指南,丙型肝炎病毒感染的透析患者的抗病毒治疗选择是单一治疗,但新的数据表明使用现代抗病毒方法(即聚乙二醇化干扰素加利巴韦林)。在一项包括151名接受联合抗病毒治疗(常规或聚乙二醇化干扰素加利巴韦林)的透析患者的汇总分析中,持续病毒应答和退出率的总估计为56% (95% CI, 28-84)和25% (95% CI, 10-40)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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