Direct-Acting Antiviral Therapy and Long-Term Outcomes in Dialysis Patients With Hepatitis C: A Real-world Cohort Study.

Background: Hepatitis C virus (HCV) infection is associated with adverse outcomes among patients with end-stage kidney disease (ESKD) receiving dialysis. Although direct-acting antivirals (DAAs) achieve high cure rates in patients with ESKD, real-world evidence regarding their long-term clinical benefits remains limited. We evaluated the association between direct-acting antiviral (DAA) therapy and long-term outcomes among dialysis patients with HCV infection. Method: We conducted a multicenter retrospective cohort study using the TriNetX research network. Adults (≥18 years) with ESKD receiving dialysis and confirmed HCV infection between 2015 and 2025 were included. Patients were classified as DAA-treated or untreated. The primary outcome was all-cause mortality; secondary outcomes included kidney transplantation, incident cirrhosis, and hepatocellular carcinoma. Propensity score matching (1:1) was performed to balance baseline covariates. Outcomes were analyzed using Cox proportional hazards models with up to 5 years of follow-up. Results: Among 7660 patients (1482 DAA-treated and 6178 untreated), 1458 matched pairs were included in the analysis. DAA therapy was associated with lower mortality (HR, 0.68; 95% CI, 0.59-0.77; Conclusions: Among patients with ESKD receiving dialysis and HCV infection, DAA therapy was associated with improved long-term survival and a higher likelihood of kidney transplantation. These findings provide real-world evidence supporting the clinical benefits of antiviral therapy and highlight the importance of expanding HCV treatment in dialysis populations.