Comparing survival between peritoneal dialysis and hemodialysis treatment in ESRD patients with chronic hepatitis C infection.

OBJECTIVE: End-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection are associated with an increasing mortality risk on hemodialysis (HD) and peritoneal dialysis (PD). The aim of this study was to compare patient survival between HCV-positive patients undergoing PD versus HD.
METHODS: We reviewed 78 PD and 78 HD patients with chronic hepatitis C infection in China Medical University Hospital from 1996 to 2006. The HD patients were selected using the propensity score matching method. Kaplan-Meier analysis with log-rank test was used to compare patient survival between patients treated with PD and those treated with HD. Possible prognostic factors were analyzed using multivariate Cox proportional hazard regression with adjustments for age, sex, and propensity score.
RESULTS: Mortality rate was 50% (39/78) for PD and 41% (32/78) for HD (chi-square test p = 0.26). Diabetes, hypertension, and cardiovascular disease were present in 43.6%, 25.6%, and 14.1% of patients, respectively. Kaplan-Meier estimate and univariate Cox regression with adjustments for age and propensity score showed that HCV patients treated with PD had a similar survival to those treated with HD (p = 0.381 and p = 0.363). In forward stepwise Cox regression, positivity for hepatitis B virus surface antigen (p < 0.001), diabetes (p = 0.009), and serum albumin (p = 0.032) were independently associated with higher mortality.
CONCLUSION: Patient survival is not different between ESRD patients with chronic hepatitis C treated with PD and those treated with HD. In ESRD patients positive for HCV, being positive for hepatitis B virus is an important prognostic factor.