Hepatitis C is less aggressive in hemodialysis patients than in nonuremic patients

• Published in: Clinical journal of the American Society of Nephrology Vol. 3; no. 5; pp. 1385 - 1390
• Main Authors: Trevizoli, Jose Eduardo, de Paula Menezes, Raissa, Ribeiro Velasco, Lara Franciele, Amorim, Regina, de Carvalho, Mauro Birche, Mendes, Liliana Sampaio, Neto, Columbano Junqueira, de Deus Macedo, José Roberto, de Assis, Francisco, Neves, Rocha
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.09.2008
• Subjects: Adult; Aged; Alanine Transaminase - blood; Case-Control Studies; Dialysis; Disease Progression; Female; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - metabolism; Hepatitis C, Chronic - pathology; Humans; Inflammation Mediators - metabolism; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - metabolism; Kidney Failure, Chronic - pathology; Kidney Failure, Chronic - therapy; Liver - enzymology; Liver - pathology; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Male; Middle Aged; Odds Ratio; Renal Dialysis; Risk Assessment; Risk Factors; Severity of Illness Index; Uremia - etiology; Uremia - therapy; Viral Load
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.01330308

The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. HCV patients on hemodialysis had lower levels of alanine aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV.