Does hepatitis C virus infection increase hematocrit and hemoglobin levels in hemodialyzed patients?

Şahin, İlyas; Arabacı, Filiz; Ha, Sahin; İlhan, Muzaffer; Üstün, Yusuf; Mercan, Rıdvan; Eminov, Lokman

doi:10.5414/cnp60401

Cited by 19 publications

(26 citation statements)

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“…Indeed, the HRs show higher risks of a hemoglobin concentration decline to ,8.5 g/dl (HR, 1.12; 95% CI, 1.03 to 1.21), transfusion (HR, 1.36; 95% CI, 1.20 to 1.55), or gastrointestinal bleeding (HR, 1.32; 95% CI, 1.13 to 1.54) among HCV+ patients. Previous smaller studies have reported varying relationships between HCV infection and hemoglobin concentration, erythropoiesis stimulating agent (ESA) dose requirement, and intravenous iron dose requirement (22)(23)(24)(25), but the larger DOPPS, with more comprehensive adjustment for case-mix, reveals no significant difference between the HCV+ and HCV2 groups in baseline hemoglobin concentration, ESA dose, ESA dose/hemoglobin ratio, or intravenous iron dose.…”

Section: Discussionmentioning

confidence: 97%

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

Goodkin

Bieber

Jadoul

et al. 2016

CJASN

132

141

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Background and objectives Hepatitis C virus (HCV) infection is widely prevalent among patients on hemodialysis (HD), but very rarely treated. The aim of our study is to evaluate the burdens of HCV suffered by patients on HD.Design, setting, participants, & measurements The Dialysis Outcomes and Practice Patterns Study is an international, prospective, cohort study of patients on HD. We reviewed the HCV status of 76,689 adults enrolled between 1996 and 2015. We compared HCV-positive (HCV+) with HCV-negative (HCV2) patients for risk of mortality, hospitalization, decline in hemoglobin concentration ,8.5 g/dl, and red blood cell transfusion. We also compared health-related quality of life scores using the Kidney Disease Quality of Life instrument and the Center for Epidemiologic Studies Short Depression Scale. We adjusted for age, sex, race, years on dialysis, 14 comorbid conditions (including hepatitis B infection), and serum albumin, phosphorus, and creatinine concentrations.Results A total of 7.5% of patients were HCV+ at enrollment. Serum concentrations of alanine aminotransferase and aspartate aminotransferase were not markedly elevated in HCV+ patients on HD; the mean concentrations were only 22.6 and 21.8 U/L, respectively. Median follow-up was 1.4 years. Case-mix adjusted hazard ratios (95% confidence intervals) for HCV+ versus HCV2 patients were 1.12 (1.05 to 1.20) for all-cause mortality, 5.90 (3.67 to 9.50) for hepatic-related mortality, 1.09 (1.04 to 1.13) for all-cause hospitalization, and 4.40 (3.14 to 6.15) for hepatic-related hospitalization. Quality of life measures indicated significantly worse scores for physical function, pain, vitality, mental health, depression, pruritus, and anorexia among HCV+ patients. The adjusted hazard ratio for transfusion was 1.36 (95% CI, 1.20 to 1.55) and incidence of hemoglobin concentration ,8.5 g/dl was 1.12 (95% CI, 1.03 to 1.21). Only 1.5% of HCV+ patients received antiviral medication.Conclusions HCV infection among patients on HD is associated with higher risk of death, hospitalization, and anemic complications, and worse quality of life scores. Internationally, HCV infection is almost never treated in patients on HD. Our data provide a rationale for more frequent treatment of HCV in this population.

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Section: Discussionmentioning

confidence: 97%

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

Goodkin

Bieber

Jadoul

et al. 2016

CJASN

132

141

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“…Recently, Sahin et al found that anti-HCV-positive patients with end-stage renal disease had higher hemoglobin and hematocrit levels than anti-HCV-negative patients. 10 Similarly, Altintepe et al concluded that anti-HCV positive patients on hemodialysis had higher serum erythropoietin levels and required less exogenous erythropoietin and iron than anti-HCV-negative patients. 11 However, the effect of HCV infection on erythropoiesis has still not been fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

Effect of hepatitis C virus infection on erythropoiesis in patients on hemodialysis

Saifan

El‐Charabaty²,

Kleiner³

et al. 2013

IJNRD

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Background: Erythropoietin is a hormone that regulates erythropoiesis and is mainly produced by the kidneys. Several animal studies as well as a few case reports and case series have demonstrated that regenerating hepatic tissue can produce more erythropoietin than normal hepatic tissue. The purpose of the study was to examine the difference in hemoglobin and hematocrit levels as well as epoetin dosage in patients on hemodialysis with and without hepatitis C (HCV). Methods: A retrospective chart review was performed. Seventy-six patients were included in the study (19 with HCV and 57 without HCV) at a ratio of 1:3. Exclusion criteria were a history of gastrointestinal bleeding or blood transfusion over the previous six months, polycystic kidney disease, and pregnancy. Variables examined included gender, age, duration of hemodialysis, hemoglobin, hematocrit, epoetin dose, aspartate transaminase, and ferritin levels over a threemonth period. Results: The patients were divided into two groups. The first consisted of patients with HCV on hemodialysis and the second of patients on hemodialysis without HCV. Mean hemoglobin was 12.6 ± 1.2 g/dL for the HCV-positive group and 11.9 ± 1.1 g/dL for the HCV-negative group. The difference was statistically significant (P = 0.03). Mean hematocrit was higher in the HCVpositive group, but was not significantly different at 39.08% ± 4.06% versus 37.43% ± 3.4% in the HCV-negative group (t-test, P = 0.11). Further, the HCV-positive group required less epoetin, but this was not significantly different from that required in the HCV-negative group at 6258 ± 5208 IU versus 7596 ± 7056 IU, respectively (t-test, P = 0.38). Conclusion: In our study, patients with HCV infection were found to have higher hemoglobin and hematocrit levels and lower epoetin requirements than those without HCV. Although the findings were not statistically significant, the computed values between these two groups of patients did follow a general trend. Further investigation with more patients, a longer duration of follow-up, and incorporation of additional medical variables is needed to clarify the role of HCV on erythropoiesis in hemodialysis patients.

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“…Chronic hepatitis C infection has been reported to be associated with a higher hemoglobin level 3 ; however, the strength of the above-mentioned study was limited because of the small number of cases and the lack of analysis for factors influencing red blood cell production. In our study, higher hemoglobin and hematocrit were significantly associated with HCV infection, but not with HBV infection.…”

Section: Discussionmentioning

confidence: 99%

“…2 HCV infection was reported to be associated with increased levels of hemoglobin (Hgb), hematocrit (Hct), 3 serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), intact parathyroid hormone (i-PTH), and serum iron 2 and with poor clinical outcomes. 4 Some studies have suggested an association between hepatitis and increased hemoglobin.…”

mentioning

confidence: 99%

Chronic Hepatitis C Infection Is Associated with Higher Hemoglobin Levels in Hemodialysis Patients, But Hepatitis B Infection Is Not

Chen¹,

Tseng²,

Huang³

et al. 2008

Dialysis & Transplantation

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BACKGROUNDChronic hepatitis is associated with increased hemoglobin level in patients with end‐stage renal disease. The aim of this study was to define the individual and combined influence of chronic hepatitis B and C infections on red blood cell status.METHODSA total of 524 chronic hemodialysis patients at 5 hemodialysis centers were retrospectively reviewed for the period from March 1 to June 31, 2005. The results of testing using a third‐generation enzyme‐linked immunosorbent assay showed that 345 patients (65.8%) had neither HBV nor HCV (NBC), 55 patients (10.5%) had HBV, 108 (20.6%) had HCV, and 16 (3.1%) had concurrent HBV and HCV infection (BBC). Differences between the 4 groups of patients in the parameters studied were investigated using a multivariate general linear model with the Sidak post hoc test.RESULTSThe hemoglobin and hematocrit of patients with HCV were 10.5 ± 1.6 g/dL and 31.6% ± 4.7%, respectively, which were significantly higher than the 9.9 ± 1.4 g/dL and 29.7% ± 4% of NBC patients (p = 0.002 and p = 0.001). The erythropoietin (EPO) dose given to patients with HCV was 39.3 ± 40.3 IU/kg/week, significantly lower than the 58.1 ± 40.6 IU/kg/week for those with NBC. The results of the multivariate linear regression analysis suggested that erythropoietin dose, elevated liver functional test results, and HCV infection were major factors affecting red cell production (p < 0.001, p < 0.02, and p < 0.05, respectively).CONCLUSIONHepatitis C virus infection was associated with an increased number of red blood cells, which led to a lowering of the necessary EPO dose, whereas hepatitis B virus infection was not.

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Does hepatitis C virus infection increase hematocrit and hemoglobin levels in hemodialyzed patients?

Cited by 19 publications

References 0 publications

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

Effect of hepatitis C virus infection on erythropoiesis in patients on hemodialysis

Chronic Hepatitis C Infection Is Associated with Higher Hemoglobin Levels in Hemodialysis Patients, But Hepatitis B Infection Is Not

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