Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Deshpande, Rati; Stepanova, Maria; Golabi, Pegah; Brown, Kimberly; Younossi, Zobair M.

doi:10.1111/jvh.13173

Cited by 7 publications

(5 citation statements)

References 35 publications

(35 reference statements)

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“…These are optimistic findings, roughly comparable to those of a recent study in the United States 52 . However, Brazil is a highly heterogeneous country, and results from pooled surveys of officially accredited clinics should be viewed with caution.…”

Section: Discussionsupporting

confidence: 87%

Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

Niquini

Mota

Bastos

et al. 2022

Sci Rep

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We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989–2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26–43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8–15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15–25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6–13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.

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Section: Discussionsupporting

confidence: 87%

Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

Niquini

Mota

Bastos

et al. 2022

Sci Rep

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“…The SBN reported a pronounced decline from to 2018 with prevalence rates of 19.9% and 3.2%, respectively, in the network of clinics under the SBN umbrella (Romão Jr et al, 2003;Neves et al, 2020). These are optimistic findings, roughly comparable to those of a recent study in the United States (Deshpande et al, 2019). However, Brazil is a highly heterogeneous country, and results from pooled surveys of officially accredited clinics should be viewed with caution, as discussed below.…”

Section: Discussionmentioning

confidence: 71%

Double Jeopardy: Persistently High Hepatitis C Rates in Haemodialysis Patients in Brazil: A Systematic Review and Meta-Analysis

Niquini

Mota

Bastos

et al. 2021

Preprint

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Background: We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil. Methods: A systematic review was carried out, followed by two independent meta-analyses. The 1 st included studies with data on HCV prevalence. The 2 nd included previous studies with a confirmatory PCR (i.e. active infection of hepatitis C). We used both Bayesian and classical statistical concepts and methods. A comprehensive set of different methods and procedures were used, including forest plots and respective statistics, polynomial regression, meta-regression, subgroup, influence, and trim and fill analysis. Results: 11,290 individuals were assessed in the pooled analyses. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95%CI:26%-43%) for studies implemented before 2001. For studies launched after 2001, the corresponding summary measure was 11% (95%CI:8%-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI:15%-25%) in studies launched before 2001, with a high degree of heterogeneity. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI: 6%-13%), again with high heterogeneity. The different analyses helped to identify the underlying sources of heterogeneity. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the various studies and by publication biases.Conclusions: CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil appears elusive, it is possible and necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV among people with CKD, among other high-risk groups.

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“…Baseline study characteristics are outlined in Table 1 . Six studies were performed in East Asia [ 15 , 16 , 20–22 , 28 ], five in Europe [ 14 , 17 , 19 , 25 , 26 ], two in the USA [ 18 , 24 ] and one in North Africa [ 27 ]. One study was multinational [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only two studies [ 18 , 23 ] described participant ethnicity. Seven studies [ 14 , 18 , 19 , 25–28 ], including the largest study involving 291 663 patients drawn from a 5% random sample of US Medicare beneficiaries [ 18 ], involved HD patients only; four [ 17 , 20 , 22 , 24 ] involved (PD) patients only. The remaining four studies [ 15 , 16 , 21 , 23 ] involved both PD and HD patients.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and outcomes of chronic liver disease in patients receiving dialysis: systematic review and meta-analysis

Swift

Sharma

Ramanarayanan

et al. 2021

Clinical Kidney Journal

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Background Patients receiving dialysis for end-stage kidney disease (ESKD) commonly co-exhibit risk factors for hepatic impairment. This systematic review and meta-analysis aimed to quantify the co-existence of chronic liver disease (CLD) and characterise risk factors and outcomes. Methods We searched the following databases from inception to May 2021: CINAHL, Cochrane Library, EMBASE, Kings Fund Library, MEDLINE and PubMed. The protocol was pre-registered on PROSPERO (study ID: CRD42020206486). Studies were assessed against three inclusion criteria: (1) adults (>18 years) with ESKD receiving dialysis (2) primary outcome involving CLD prevalence (3) publications in English. Moderator analysis was performed for age, gender, study size, and publication year. Sensitivity analysis was performed where applicable by removing outlier results and studies at high risk of bias. Results Searches yielded 7,195 articles, 15 met the inclusion criteria. 320,777 patients were included. Prevalence of cirrhosis and non-alcoholic fatty liver disease (NAFLD) was 5% and 55%, respectively. Individuals with CLD had two-fold higher mortality than those without (OR 2.19; 95% confidence interval 1.39-3.45). Hepatitis B (OR 13.47;1.37-132.55) and hepatitis C (OR 7.05; 4.00-12.45), but not diabetes, conferred increased cirrhosis risk. All studies examining NAFLD were judged to be at high risk of bias. We found no data on non-alcoholic steatohepatitis (NASH). Deaths from CLD, cancer and infection were greater amongst cirrhotic patients. Conclusions CLD is prevalent in dialysis patients. Hepatitis B and C confer increased risk of CLD. The impact of NAFLD and NASH cirrhosis requires further study. CLD associates with increased mortality risk in this setting.

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Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Cited by 7 publications

References 35 publications

Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

Double Jeopardy: Persistently High Hepatitis C Rates in Haemodialysis Patients in Brazil: A Systematic Review and Meta-Analysis

Prevalence and outcomes of chronic liver disease in patients receiving dialysis: systematic review and meta-analysis

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