Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic… — Volkswagen Brasilia

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Volkswagen Brasilia

Hepatitis C Is Less Aggressive in Patients than in Nonuremic

Abstract

Background and objectives: The of liver disease among C patients on hemodialysis is controversial. The aim of study was to compare the clinical, and liver histologic characteristics of C virus (HCV) in hemodialysis and in those with normal function.

Design, setting, measurements: A case-control study was out with 36 HCV patients on hemodialysis and 37 HCV with normal renal matched for gender, age at infection, and time of infection.

Results: HCV on hemodialysis had lower levels of aminotransferase and lower viral Hepatic fibrosis was significantly in the patients with normal function (73%) than in patients (47.2%, P 0.025); the was observed for inflammatory activity group 59.5% versus patients 27.7%, P = 0.003). In the risk of tissue inflammation was times lower in hemodialysis (odds ratio = 0.23, P and severe inflammatory activity on was the only independent risk for fibrosis ( P 0.001).

Conclusions: The lower biochemical and activities observed in hemodialysis suggest that hemodialysis and may have a protective role progression of the disease caused by

Hepatitis C is the main cause of liver disease in patients end-stage renal disease The prevalence of hepatitis C virus (anti-HCV) is high, between and 32.1%, among hemodialysis patients and potential kidney candidates (1 ). Despite the decrease in the of newly acquired HCV infections in recent years, which may be to the efficient serologic HCV tests in blood transfusions and to the use of erythropoietin to anemia, contamination by HCV still in HD units (2 ).

Patients infected HCV who undergo renal transplantation a higher risk for progression to liver disease, death, and failure after transplantation with anti-HCV negative (3 ). Liver disease should be staged at the time of kidney because patients with or advanced fibrosis will a poorer prognosis (4 ).

The natural of chronic liver disease by HCV in HD patients remains unknown (4 –6 ). HCV increases mortality rates in patients, and cirrhosis and other deaths are more frequent in dialysis patients than in without the virus (5 –7 ).

Results from liver of HCV-infected dialysis patients are (1 ,2 ), and the rate of bridging hepatic and liver cirrhosis ranges 5% to 32% (8 –15 ). Whether the liver disease by HCV shows a different clinical in HD patients and in patients with renal function is still Barril (8 ) reported that time to cirrhosis can be much in HCV-infected HD patients than in with normal renal However, other studies that HCV-infected HD patients a lower degree of inflammatory and a lower stage of liver compared with HCV-infected with normal renal (9 ,12 ,15 ). Indeed, the effects of chronic and HD on HCV-related liver disease and on the of liver fibrosis in HCV-infected with ESRD remain

To investigate the impact of chronic failure and HD on the progression of hepatitis C in awaiting kidney transplantation, we clinical, biochemical, virologic, and findings in HCV-infected patients ESRD receiving HD treatment and in patients with normal function. Our results showed HCV-infected patients on HD presented levels of alanine aminotransferase lower viral load, and inflammatory activity and fibrosis in liver biopsies. Moreover, inflammatory activity was the only risk factor for liver Taken together, our results suggest that chronic C is less aggressive in HD patients in nonuremic patients.

Materials and Methods

This study was conducted from 2000 to December 2006 and 36 HD patients enrolled in the kidney waiting list of Hospital de do Distrito Federal, Brasília, Federal, Brazil. Subjects selected among 761 patients ESRD who had been treated for at 6 mo in seven HD units located in the area of Brasília. From population, 101 patients were for anti-HCV antibody (enzyme-linked assay 3) and 76 patients were HCV RNA Of these 76 patients, 36 had been to liver biopsy because were awaiting renal (case group). The control comprised 37 HCV-infected patients normal renal function, by creatinine ≤1 mg/dl.

Date of onset of HCV infection was considering the date when HD was or the year when the patient a blood transfusion (if before the of HD) in the study group, and the date of the blood transfusion in the control Exclusion criteria for both were: coinfection with B virus or HIV, chronic use of interferon, or ribavirin; other diseases; intravenous drug alcohol consumption of more 40 g/d for men and 20 g/d for women. The control group was with the study group for sex, and estimated time of HCV All patients underwent clinical, serologic, virologic, sonographic, and studies, and the results were between the two groups.

Clinical

Data about age, risk factors, estimated of onset of HCV infection, possible HCV mode, body mass and history of diabetes mellitus obtained from clinical and review of charts. The diagnosis of mellitus was made according to of use of oral hypoglycemic agents or and fasting glycemia level mg/dl).


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Laboratory Studies

Blood were collected for the following tests: glucose, ALT, proteins, albumin, platelets, saturation, and prothrombin activity Normalized Ratio). ALT levels calculated as the mean of the three performed in the 6 mo before the first whereas the other tests carried out around the date of the biopsy.

Serologic and Molecular

Histologic Tests

Statistical

Descriptive data were as percentages or means with SD and Categorical variables were with the χ 2 test and Fisher test. The t test and Mann-Whitney were used for comparison of variables. Logistic regression were used to calculate ratios (95% confidence and the corresponding P values. The level of was set at 0.05 (alpha = 5%). analyses were performed the SPSS 13.0 software for

Approval by Research Ethics

Results

Among the 76 HD patients infected by 36 who were in the kidney transplant were included in the study, as as 37 HCV-infected patients with renal function. No difference was between the 36 HD patients awaiting transplantation and the remaining 40 HD patients who not enrolled in the kidney transplant in terms of ALT, total albumin, platelets, transferrin prothrombin activity (International Ratio), and abdominal ultrasound.

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