The effect of hemodialysis on liver stiffness measurement

Kellner, Paul; Anadol, Evrim; Hüneburg, Robert; Hundt, Felix; Bös, Dominik; Klein, Burkhard; Woitas, Rainer P.; Spengler, Ulrich; Sauerbruch, Tilman; Trebicka, Jonel

doi:10.1097/meg.0b013e32835ad180

Cited by 16 publications

(13 citation statements)

References 25 publications

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“…The withdrawal of fluid during HD influences liver stiffness measurement results, even in patients without viral hepatitis infection. Kellner et al showed that a significant increase in liver stiffness measurement was found after HD in patients with an initial level lower than 7.1 kPa (28). In our study, for patients with chronic viral hepatitis, F3 stage liver fibrosis was a risk factor for TCP.…”

Section: Discussionsupporting

confidence: 52%

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Orășan¹,

Urian²,

Ciulei³

et al. 2018

JMMS

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Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis. Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis. Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels > 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age > 60 years, dialysis vintage > 10 years, aspartate and alanine aminotransferase levels > 20 IU/L, albumin levels < 3.5 g/dl, and fibrosis stage ≥ 3 were not related. Conclusions. Chronic viral hepatitis leads to a higher prevalence of thrombocytopenia. Platelet counts in these patients begin to decrease significantly once liver fibrosis reaches stage III. Keywords  thrombocytopenia, end-stage renal disease, chronic viral hepatitis Highlights ✓ Thrombocytopenia is a common occurrence in patients with end-stage renal disease undergoing hemodialysis; ✓ Chronic viral hepatitis B or C in end-stage renal disease patients does not impact platelet counts, suggesting that the natural course of liver disease is slowed in subjects undergoing hemodialysis

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Section: Discussionsupporting

confidence: 52%

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Orășan¹,

Urian²,

Ciulei³

et al. 2018

JMMS

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“…Sample size calculation was carried out from the mean LSM difference of 1.5 kPa and σ of 2.6 [14] , with a 2-tailed α of 0.05 and a power (β) of 0.80. Thus, 32 patients were required in each group.…”

Section: Resultsmentioning

confidence: 99%

“…As such, TE may have some limitation in patients with fluid overload. Recently, a study showed an increase in LSM after HD in a group with an initial TE <7.1 kPa (p = 0.05) [14] . Nevertheless, the difference of pre-and post-HD LSMs in ESRD patients could not be demonstrated in our study.…”

Section: Discussionmentioning

confidence: 97%

Transient Elastography in End-Stage Renal Disease Patients on Hemodialysis: The Effect of Net Fluid Withdrawal

Khunpakdee

Jayanama²,

Kaewdoung³

et al. 2015

Blood Purif

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Background/Aims: The impact of volume status on liver stiffness measurement (LSM) as measured by transient elastography (TE) as in end-stage renal disease (ESRD) was unclear. We evaluated LSM before and after hemodialysis (HD) and identified the associated factors if the difference of LSM existed. Methods: A cross-sectional study was conducted in ESRD patients on regular HD. Subjects underwent TE and bioelectrical impedance before and after HD. Results: Thirty-six patients were enrolled. Mean (SD) net fluid withdrawal volume (NFWV) per session was 2.55 (0.9) l. Median (range) pre- and post-HD LSMs were 5.38 (2.8-25.7) and 5.4 (2.8-26) kPa, respectively (p = 0.712). Mean differences of pre- and post-HD LSMs correlated with NFWV (r = 0.49, 95% CI 0.19-0.71, p = 0.002). Conclusion: In ESRD on regular HD, LSM is not affected by HD. TE can be done before or after HD with similar results. However, fluid excess at pre-HD can cause inaccurately high LSM.

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“…A decision tree for the follow-up process is shown in Figure 1. Treating HCV infection prior to KT helps to prevent post-transplantation complications and reduce mortality [3,[39][40][41][42] . There is general agreement that ESRD patients with decompensated cirrhosis and portal hypertension should be removed from the KT list and referred to the liver transplant team to be considered for combined liver-KT [43] .…”

Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 99%

“…Studies have demonstrated that APRI and TE are effective for evaluating hepatic fibrosis in HD patients with chronic HCV infection, but both methods have some limitations [37,38] . The predictive values and cut-off values for these methods as optimized for the healthy population may not be valid for ESRD patients [39] . As well, the HD procedure and the presence of uremic toxins may alter blood levels of apolipoprotein A1 and α-2 macroglobulin, which can influence Fibroscan ® results [37] .…”

Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 99%

Hepatitis C infection in hemodialysis patients: A review

Etık

Öcal

Boyacioglu

2015

WJH

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Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications posttransplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.

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The effect of hemodialysis on liver stiffness measurement

Cited by 16 publications

References 25 publications

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Transient Elastography in End-Stage Renal Disease Patients on Hemodialysis: The Effect of Net Fluid Withdrawal

Hepatitis C infection in hemodialysis patients: A review

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