Enliven: Nephrology and Renal Studies

Background:
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are frequent among Egyptians hemodialysis patients. Anemia is the most common hematological abnormality in end stage renal disease (ESRD). Long-term effects of HBV and HCV on red blood cell status in ESRD patients are unknown.

Objective:
To determine the influence of HBV, HCV, and concurrent HBV and HCV infection on anemia in maintenance hemodialysis patients.

Methods:
Retrospective study was performed; one hundred and seven hemodialysis patients were enrolled in the study between Jun 2013 to Mar 2014. According to the results of third-generation enzyme-linked immunosorbent assay and RNA polymerase chain reaction (PCR) the study populations were classified into 44 patients had neither HBV nor HCV (NBC), 22 had HBV positive (HBV), 31 had HCV positive (HCV), and 10 had both HBV/HCV positive (BBC). Differences between the 4 groups of patient variables, including, age, gender, cause of ESRD, duration of hemodialysis, hemoglobin, hematocrit, liver enzymes, iron and ferritin levels, intravenous (IV) Iron dose mg/month and erythropoietin (EPO) dose IU/ month were assessed.

Results:
The mean value of hemoglobin (HB) and hematocrit (HCT) of patients with HCV were (11.4±1.3; 33±7.2) respectively, which were significantly higher than the mean value of HB and HCT of NBC (8.8±1.2; 31±5.9), HBV (8.9±1.2; 30±8.8) and BBC (9.0±1.3; 28±1.6) patients (P=0<001; P<0.001) respectively. The IV Iron mg/month and EPO IU/ month doses given to patients with HCV were significantly lesser than the doses given to NBC, HBV and BBC patients (P<0.05; P<0.05) respectively. Although age, gender, duration of hemodialysis, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum iron, serum ferritin, transferrin saturation (TSAT), IV Iron supply and EPO were assessed for association with HB and HCT respectively in HCV group. Only AST, ALT, serum iron, serum ferritin and TSAT were positively correlated with HB and HCT in HCV patients. In the meantime, iron supply and EPO doses, were negatively correlated with HB (P=0. 008; P=0. 001) and HCT (P=0. 05; P=0. 001) respectively.

Conclusion:
Hepatitis C infection in hemodialysis patients tends to have higher baseline hemoglobin and decreased need for EPO therapy. However, similar findings were not found in other groups.