HCV Linked to Increased Risk of Peripheral Artery Disease in Hemodialysis Patients

Wan-Long Chuang, MD

Credit: World Journal of Gastroenterology

Hepatitis C virus (HCV) infection may increase the risk of peripheral artery disease (PAD) in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis, according to findings from a recent study.¹

Results showed HCV infection was linked to elevated brachial-ankle pulse wave velocity (baPWV) levels, indicative of a heightened risk of PAD. Further analysis revealed individuals with a higher viral load and genotype 1 were significantly associated with an increased risk of PAD.¹

“This study represents the first investigation into the relationship between HCV infection and elevated baPWV levels in individuals undergoing hemodialysis,” Wan-Long Chuang, MD, a chair professor in the school of medicine at Kaohsiung Medical University in Taiwan, and colleagues wrote.¹

Estimated to affect more than 200 million adults worldwide, PAD usually involves atherosclerotic disease in the abdominal aorta, iliac, and femoral arteries. Known risk factors include smoking, diabetes, obesity, and high blood pressure and cholesterol.2 While HCV and ESRD have also been linked to an increased risk of PAD, investigators noted the relationship between HCV infection and the risk of arteriosclerosis in maintenance hemodialysis patients is not well understood.¹

To explore the association between HCV infection and PAD in hemodialysis patients, investigators conducted a prospective study of patients ≥ 20 years of age who were on maintenance hemodialysis therapy 3 times a week using a Toray 321 machine for ≥ 3 months at Kaohsiung Municipal Siaogang Hospital.¹

BaPWV were measured 10-30 min before hemodialysis using the ABI-form device that automatically and simultaneously measured blood pressure in both arms and ankles through the oscillometric method. Anti-HCV antibody and hepatitis B surface antigen were tested through Chemiluminescence, and HCV RNA levels and HCV genotypes were determined using commercially available real-time PCR assays (RealTime HCV, low limit of detection, 12 IU/mL and Abbott RealTime HCV Genotype II).¹

Investigators noted all patients in the study cohort were enrolled in 2016, predating the initiation of direct-acting antiviral (DAA) treatment covered by the Taiwan national health reimbursement system. All baPWV assessments were conducted before the introduction of DAA treatment, and none of the patients with HCV infection had previously undergone interferon-based treatment.¹

In total, the study enrolled 210 patients who underwent routine hemodialysis, 36 of whom were HCV-positive, with 1b (52.4%) being the most common genotype. Among these patients, 27 underwent HCV RNA level assessments and 6 were found to have undetectable HCV RNA levels. Among the remaining 21 patients with detectable HCV RNA levels, the mean HCV RNA level was 1275.38 ± 2587.41 × 103 IU/mL.¹

Investigators noted there were no differences in mean age or BMI between the groups with and without HCV infection. However, they called attention to a significant difference in the duration of hemodialysis, which was longer in the HCV-infected group (134.4 ± 94.0 months vs 82.8 ± 62.3 months; P = .002).¹

Individuals with HCV infection exhibited greater baPWV levels compared with those without HCV infection (2006.0 ± 687.4 vs 1809.3 ± 466.1 cm/s; P = .039). Of note, baPWV levels were significantly positively correlated with age (r = .29; P < .001) and AST (r = .15; P = .035), while displaying a negative correlation with hemodialysis duration (r = −.21; P = .002), albumin (r = −.20; P = .004), and LDL-C (r = −.15; P = .034).¹

Further analysis revealed the presence of HCV infection (β, 199.56; 95% CI, 10.56 to 388.56; P = .039) exhibited a significant positive correlation with baPWV levels. Age (β, 8.07; 95% CI, 1.69 to 14.46; P = .013) and diabetes mellitus (β, 235.11; 95% CI, 84.51 to 385.72; P = .002) were also positively correlated with baPWV levels.¹

In multivariate logistic regression analysis, HCV infection (odds ratio [OR], 2.67; 95% CI, 1.07-6.68; P = .036) was significantly associated with baPWV >2100 cm/s, as were diabetes mellitus (OR, 3.97; 95% CI, 1.78 to 8.84; P = .001); age (OR, 1.04; 95% CI, 1.01 to 1.08; P = .019); BMI (OR, 0.87; 95% CI, 0.77 to 0.97; P = .015); and ALT (OR, 6.64; 95% CI, 1.31 to 33.66; P = .022).¹

Investigators pointed out a higher viral load (HCV RNA ≥60 × 103 IU/mL) was associated with baPWV ≥2100 cm/s when compared with non-HCV infection patients (OR, 4.45; 95% CI, 1.12 to 17.68; P = .034). Additionally, they noted genotype 1 was also significantly associated with baPWV ≥2100 cm/s (OR, 8.13; 95% CI, 2.04 to 32.42; P = .003).¹

“Our findings reveal that among uremic patients, HCV infection has significantly heightened risk of PAD, as indicated by baPWV surpassing 2100 cm/s,” investigators concluded.¹ “Furthermore, there is a notable association between an increased risk of PAD and higher viral load as well as genotype I among patients with HCV infection.”

References

1. ^{Wang CW, Chen SC, Huang CF, et al. Hepatitis C virus infection increases risk of peripheral arterial disease in end-stage renal disease patients receiving maintenance hemodialysis therapy. Advances in Digestive Medicine. https://doi.org/10.1002/aid2.13432}
2. ^{Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. StatPearls. May 23, 2023. Accessed October 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK430745/}