CLINICAL OUTCOMES AND MORTALITY PREDICTORS IN HEPATITIS B AND C POSITIVE CHRONIC LIVER DISEASE PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS IN RESOURCE-LIMITED SETTINGS: A PROSPECTIVE COHORT STUDY

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https://storage.unitedwebnetwork.com/files/1099/41347c4531cc5cdfe65cf9966b5c1f6b.pdf

Abstract Title *

CLINICAL OUTCOMES AND MORTALITY PREDICTORS IN HEPATITIS B AND C POSITIVE CHRONIC LIVER DISEASE PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS IN RESOURCE-LIMITED SETTINGS: A PROSPECTIVE COHORT STUDY

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Co-author 1

YOGESH GAUR dryogeshnephro@gmail.com HERITAGE INSTITUTE OF MEDICAL SCIENCES NEPHROLOGY VARANASI India *

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Introduction

Patients on maintenance hemodialysis (MHD) have higher prevalence and worse outcomes from chronic viral hepatitis (HBV/HCV). New direct-acting antivirals (DAAs) achieve high cure (SVR) rates for HCV including in CKD/ESRD, and oral nucleos(t)ide analogues (entecavir, tenofovir variants) form the backbone of HBV therapy; dosing and safety considerations differ in dialysis populations and must be followed. Recent guideline updates support use of many SOF-containing regimens and pangenotypic DAAs in ESRD, and recommend long-term entecavir or tenofovir for HBV with renal dose considerations.

Methods

In this 24-month prospective cohort, 60 adult CLD patients on MHD (HCV = 34, HBV = 18, coinfected = 8) were followed in a public-sector dialysis program. Direct-acting antivirals (glecaprevir/pibrentasvir or sofosbuvir/velpatasvir) were used for HCV; entecavir or tenofovir alafenamide/disoproxil for HBV with renal dosing. Outcomes included mortality, sustained virologic response (SVR12), HBV DNA suppression, seroconversion, and nosocomial sero-transmission. Predictors of mortality were assessed by Cox regression

Results

DAA therapy achieved SVR12 in 93.3% of treated HCV patients (28/30). HBV DNA suppression occurred in 66.7% (10/15) and HBsAg loss in 5.6%. Overall 24-month mortality was 20%. Independent mortality predictors were serum albumin < 3.5 g/dL (aHR 2.50, p = 0.045) and cirrhosis (aHR 2.75, p = 0.048). Antiviral therapy showed a protective trend (aHR 0.55). Annual HBV vaccination (89.5% seroprotection) and strict segregation reduced incident infections to zero in segregated units.

Conclusion

Low albumin and cirrhosis predicted mortality in HBV/HCV-positive CLD patients on MHD. Vaccination, segregation, and timely antiviral therapy were safe, feasible, and associated with improved virologic and survival outcomes in resource-limited dialysis settings.

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