Effects of hepatitis C virus infection on haematocrite and haemoglobin levels in Egyptian hemodialysis patients

Anahtar Kelimeler:

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Effects of hepatitis C virus infection on haematocrite and haemoglobin levels in Egyptian hemodialysis patients

Aim: Hepatitis C virus (HCV) infection is common among the Egyptians. This prevalence is higher among hemodialysis (HD) patients in whom anemia is a common finding. Recently, some case reports and few studies indicated that red cell status increased after hepatitis C viral infection among HD patients. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods: Ninety-nine chronic (HD) patients were the subject of this study. Their HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last 6 months were excluded from the study. Results: 70.7% of our patients tested positive for anti-HCV antibody (56.9 % were male). The mean age for HCV positive group was (40.41±14.17 years) while it was (47.35±19.18 years) for HCV negative group (P=0.08). HCV positive group has a longer hemodialysis duration (66.54 ± 43.92 months) compared to HCV negative patients (30.96±23.17 months, P=0.006). Mean Hb was similar in HCV-positive compared to HCV negative group (10.32±2.03 versus 10.22±1.52 gm/dl respectively) (P=0.63). Mean HCT values were also similar in both groups being 30.94± 6.089% in HCV positive versus 30.77± 4.53% in HCV negative group, respectively (P= 0.094). Fifty-five patients (39 HCV positive and 16 were HCV negative) received erythropoietin (EPO) therapy whilst only twenty patients received IV iron. Mean Erythropoietin dose was 5000±2236.06 Units/week in HCV- positive patients versus 6250±2720.29 Units /week in HCV - negative group (P=0.09). Liver function tests were normal except for alanine aminotransferase (ALT) that was significantly higher among HCV-positive compared to HCV-negative patients (31.75±36.4 vs 15.1±7.21 U/L, P=0.05). Conclusion: HCV-positive and HCV-negative Egyptian chronic hemodialysis patients have comparable hemoglobin as well as hematocrit levels and the erythropoietin dose was not influential as its lower value in HCV-positive patients did not reach a statistically significant level

Keywords:

Hepatitis C virus, Haematocrit, haemoglobin hemodialysis,

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1. Butt AA. Hepatitis C virus infection: the new global epidemic. Expert Rev Anti Infect Ther 2005;3(2):241-9
2. Natov SN. Hepatitis C virus in chronic dialysis patients. Minerva Urol Nefrol. 2005; 57(3):175-97
3. Nguyen MH, Keeffe EB. Prevalence and treatment of hepatitis C virus genotypes 4, 5, and 6. Clin Gastroenterol Hepatol 2005;3 (10 Suppl 2):S97-S101
4. Savey A, Simon F, Izopet J, Lepoutre A, Fabry J, Desenclos JCA. Large nosocomial outbreak of hepatitis C virus infections at a hemodialysis center. Infect Control Hosp Epidemiol 2005;26(9):752- 60
5. Silva IS, Perez RM, Oliveira PV, et al. Iron overload in patients with chronic hepatitis C virus infection: clinical and histological study. J Gastroenterol Hepatol 2005;20(2):243-8
6. Theurl I, Zoller H, Obrist P, et al. Iron regulates hepatitis C virus translation via stimulation of expression of translation initiation factor 3. J Infect Dis 2004; 190(4):819-25
7. Distante S, Bjoro K, Hellum KB, et al. Raised serum ferritin predicts nonresponse to interferon and ribavirin treatment in patients with chronic hepatitis C infection. Liver 2002; 22(3): 187-9
8. Altintepe L, Kurtoglu E, Tonbul Z, Yeksan M, Yildiz A, Turk S. Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection. Clin Nephrol 2004;61(5):347-51
9. Abdalla AH, Owda AK, Fedail H et al. Influence of hepatitis C virus infection upon parenteral iron and erythropoietin responsiveness in regular hemodialysis patients. Nephron 2000;84:293-4
10. Sabry AA, Sobh MA, Irving WL, et al. A comprehensive study of the association between hepatitis C virus and glomerulopathy. Nephrol Dial Transplant 2002;17:239-45
11. Wasley A, Alter MJ. Epidemiology of hepatitis C: geographic differences and temporal trends. Semin Liver Dis 2000; 20:1–16
12. Natov SN, Pereira BJG. Hepatitis C infection in patients on dialysis. Semin Dial 1994;7:360-8
13. Mahmoud IM, Sobh MA, Amer MG, et al. A prospective study of hepatitis C viremia in renal allograft recipients. Am J Nephrol 1999;19:576-85
14. Djordjevic V, Stojanovic K, Stojanovic M, Stefanovic V. Prevention of nosocomial transmission of hepatitis C infection in a hemodialysis unit. A prospective study. Int J Artif Organs 2000;23:181–8
15. Fabrizi F, Martin P. Hepatitis C virus infection in dialysis: an emerging clinical reality. Int J Artif Organs 2001;24:123- 30
16. Carvalho M, Branco PB, Luvizotto ML, et al. High prevalence of hepatitis C virus infection in chronic hemodialysis patients. Braz J Infect Dis 1999;3:144–8
17. Pereira BJG. Hepatitis C virus infection in dialysis: A continuing problem. Art Orgns 1999;23:51-60
18. Wolfgang Jelkmann W. The role of the liver in the production of thrombopoietin compared with erythropoietin. European J Gastroenterol Hepatology 2001;13:791- 801
19. Zhang F, Laneuville P, Gagnon RF, Morin B, Brox AG. Effect of chronic renal failure on the expression of erythropoietin message in a murine model. Exp Hematol 1996;24:1469-74
20. Radovic M, Jelkmann W, Djukanovic L, Ostric V. Serum erythropoietin and interleukin-6 levels in hemodialysis patients with hepatitis virus infection. J Interferon Cytokine Res 1999;19:369-73
21. Faquin WC, Schneider TJ, Goldberg MA. Effect of inflammatory cytokines on hypoxia-induced erythropoietin production. Blood 1992;79:1987-94
22. Fandrey J, Pagel H, Frede S, Wolff M, Jelkmann W. Thyroid hormones enhance hypoxia-induced erythropoietin production in vitro. Exp Hematol 1994; 22:272-7
23. Jelkmann W, Pagel H, Hellwig T, Fandrey J. Effects of antioxidant vitamins on renal and hepatic erythropoietin production. Kidney Int 1997;51:497-501
24. Fandrey J, Frede S, Jelkmann W. Role of hydrogen peroxide in hypoxia induced erythropoietin production. Biochem J 1994;303:507-10
25. Sahin I, Arabaci F, Sahin HA, et al. Does hepatitis C virus infection increase hematocrit and hemoglobin levels in hemodialyzed patients. Clin Nephrol 2003;60(6):401-4
26. Chan N, Barton C, Mirahamdi MS, Gordon S, Vaziri ND. Erythropoiesis associated with viral hepatitis in end–stage renal disease. Am J Med Sci 1984;287:56-8
27. Simon P, Meyrier A, Tanquerel T, Ang KS. Improvement of anemia in hemodialyzed patients after viral or toxic hepatic cytolysis. Br Med J 1980;280:892-94
28. RadovicM, Jelkmann W, Djukanovic L, Ostric V. Serum erythropoietin and interlukin-6 levels in hemodialysis patients with hepatitis virus infection. J Interferon Cytokine Res 1999;19:69-73
29. Özdemir A, Yalınbaş B, Selamet U , Et al. Relationship between iron replacement and hepatic functions in hepatitis C virus-positive chronic haemodialysis patients. Nephrology (Carlton) 2005;10: 433–37
30. Sabry AA , Sobh MA , Sheaashaa HA, et al. Effect of combination therapy (ribavirin and interferon) in HCV-related glomerulopathy. Nephrol Dial Transplant 2002;17:1924–30
31. Kaufman JS, Reda DJ, Fye CI, et al. Diagnostic value of iron indices in hemodialysis patients receiving epoetin. Kidney Int 2001;60:300–8
32. Tarng DC, Huang TP, Chen TW, Yang WC. Erythropoietin hyporesponsiveness: From iron deficiency to iron overload. Kidney Int 1999;69 (Suppl.):107–18
33. Birgegard G. Erythropoiesis and inflammation. Contrib Nephrol 1989;76: 330-39
34. Mecans RT, Krantz SB. Progress in understanding the pathogenesis of the anemia in chronic disease. Blood 1992; 80: 1639-47