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

Abstract

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.

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

“…ERI values of anti-HCV-positive patients were lower than those of anti-HCV-negative ones; however, the difference wasn't statistically significant. This is in agreement with a recent study [52] which found that average required dose of Epo was lower in the anti-HCV-positive group than in the anti-HCVnegative group.…”

Association between interleukin-6 gene polymorphism and iron regulation in hemodialysis patients infected with HCV

“…HD duration was significantly longer in HCV-positive HD patients than in HCV-negative HD patients, as patients with HCV infection spent a significantly longer time (P≤0.001) on hemodialysis than those without HCV infection. These findings were supported by Saifan et al 20 .…”

Evaluation of hepcidin level in chronic hepatitis C Egyptian patients undergoing regular hemodialysis

“…In the present study, it was observed that hemodialysis duration was significantly longer in HCV-positive patients than in HCV-negative patients, as patients with HCV infection spent a significantly longer time [P < 0.001] on hemodialysis than those without HCV infection. These findings were supported by Saifan et al, 2013. We found that HCV hemodialysis patients displayed normal ALT and AST levels in comparison with HCV-negative hemodialysis patients. This agrees with the result of Contreras et al, 2007.…”