Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

Abstract

Background and objectives: 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.Design, setting, participants, & measurements: 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.Results: HCV patients on hemodialysis had lower levels of alanina 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).Conclusions: 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.

Hepatitis C Virus and End Stage Renal Disease

“…As in other studies, HCV/ESRD had lower ALT levels. Review of liver biopsy specimens by a blinded pathologist demonstrated significantly increased fibrosis and inflammation in patients with normal renal function (p=0.025 and 0.003, respectively) [9]. Similar results have been previously demonstrated [39].…”

“…As mentioned, HCV/ESRD patients may have near normal ALT levels and low HCV viral loads [38]. Trevizoli [9] compared biochemical parameters and liver biopsies in 73 HCV patients with normal renal function and ESRD during a mean follow-up of about 12 years. As in other studies, HCV/ESRD had lower ALT levels.…”

“…The role of HCV in the natural history ESRD and vice-versa remain controversial. HCV may increase mortality in ESRD [8], but may also be associated with delayed progression of liver disease and decreased erythropoietin (EPO) requirements [9,10].…”

Hepatitis C comorbidities affecting the course and response to therapy

“…Although patients on dialysis tend to have milder liver disease and normal liver enzymes compared with patients with normal renal function [70] , patients with end-stage renal disease (ESRD) and CHC might have severe chronic hepatitis on liver biopsy [71] . A liver biopsy should be performed in patients with CHC who are receiving hemodialysis [72] and do not have major comorbidities.…”

High Incidence of Hepatocellular Carcinoma in ESRD Patients: Caused by High Hepatitis Rate or 'Uremia'? A Population-based Study

“…On the other hand, chronic dialysis patients often presented with occult viral hepatitis with less prominent clinical manifestations (14,15), as well as lower serum aminotransferase activity (16). Moreover, ESRD with HCV infection also has been suggested to have a less progressive course of liver disease (17). Does this unique response to hepatitis modify the survival of ESRD patients developing HCC?…”