Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Kidney Int. 2019 Apr;95(4):939-947. doi: 10.1016/j.kint.2018.11.038.
Hepatitis C virus (HCV) infection is common in dialysis patients and is associated with increased morbidity and mortality. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS, 1996-2015) to assess trends in the prevalence, incidence, and risk factors for HCV infection as defined by a documented diagnosis or antibody positivity. Among prevalent hemodialysis patients, HCV prevalence was nearly 10% in 2012-2015. Prevalence ranged from 4% in Belgium to as high as 20% in the Middle East, with intermediate prevalence in China, Japan, Italy, Spain, and Russia. HCV prevalence decreased over time in most countries participating in more than one phase of DOPPS, and prevalence was around 5% among patients who had recently (<4 months) initiated dialysis. The incidence of HCV infection decreased from 2.9 to 1.2 per 100 patient-years in countries participating in the initial phase of DOPPS. Although most units reported no seroconversions, 10% of units experienced 3 or more cases over a median of 1.1 years. High HCV prevalence in the hemodialysis unit was a powerful facility-level risk factor for seroconversion, but the use of isolation stations for HCV-positive patients was not associated with significantly lower seroconversion rates. Overall, despite a trend toward lower HCV prevalence among hemodialysis patients, the prevalence of HCV infection remains higher than in the general population. Combined with a high prevalence of HCV infection among patients with Stage 5 CKD, high rates of HCV seroconversion in a subset of hemodialysis units may contribute to this disparity.
丙型肝炎病毒（HCV）感染在透析患者中很常见，与发病率和死亡率增加有关。我们使用透析结果和实践模式研究（DOPPS，1996-2015 年）评估了 HCV 感染的患病率、发病率和危险因素的趋势，这些感染是通过有记录的诊断或抗体阳性来定义的。在现患血液透析患者中，2012-2015 年 HCV 的患病率接近 10%。患病率从比利时的 4%到中东的 20%不等，中国、日本、意大利、西班牙和俄罗斯的患病率处于中间水平。在参与 DOPPS 多个阶段的大多数国家中，HCV 的患病率随时间呈下降趋势，最近（<4 个月）开始透析的患者的患病率约为 5%。在参与 DOPPS 初始阶段的国家中，HCV 感染的发病率从每 100 患者年 2.9 例降至 1.2 例。尽管大多数单位报告没有血清转换，但 10%的单位在中位数为 1.1 年的时间里发生了 3 例或更多病例。血液透析单位的 HCV 高患病率是发生血清转换的强有力的机构风险因素，但为 HCV 阳性患者使用隔离站并不能显著降低血清转换率。总体而言，尽管血液透析患者中 HCV 的患病率呈下降趋势，但 HCV 感染的患病率仍高于一般人群。再加上 5 期 CKD 患者中 HCV 感染的高患病率，血液透析单位中 HCV 血清转换率的高比例可能导致了这一差异。
