Effect of Hepatitis C Virus on Hemoglobin and Hematocrit Levels in Saudi Hemodialysis Patients

Abstract

Background. Hepatitis C virus infection is common among patients undergoing hemodialysis, and HD patients are at high risk for infection with such virus. Recently, some studies and case reports indicated attenuated anemia in HD patients with HCV infection, and they previously considered this to be related to increased erythropoietin production after hepatic stimulation by chronic infection with hepatitis virus. Aim. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods. We retrospectively studied 83 chronic HD patients from Prince Salman Center for Kidney Disease, and monthly samples were collected between July 2007 and July 2008. The HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last six months were excluded from the study. Results. Thirty-three percent of our patients tested positive for anti-HCV antibody (51.8% were male). The mean age for HCV-positive group was 54.92 ± 15.61 years, while it was 51.01 ± 14.81 years for the HCV-negative group (p = 0.27). Mean Hb in the HCV-positive group was 11.18 ± 1.41gm/dL compared to 10.87 ± 1.29 gm/dL for the HCVnegative group (p = 0.05). Mean HTC values for the HCVpositive group was 34.4 ± 3.9, compared to 32.41 ± 3.41 for the HCV-negative group 12 months after starting hemodialysis. Eighty-one patients (27 HCV-positive and 54 HCVnegative) received erythropoietin (EPO) therapy. Seventytwo patients (25 HCV-positive and 47 HCV-negative) received IV iron (p = 0.28). Mean erythropoietin dose was (114.83 ± 84.92 IU/kg/week) for HCV-positive compared to (122.2 ± 91.46 IU/kg/week) for HCV-negative group (p = 0.74). Liver function tests were normal except for higher bilirubin level in the HCV-positive group, 7.74 ± 4.03 Umol/L compared to 5.47 ± 3.71 Umol/L in the HCV-negative group (p = 0.01). Conclusion. Our study showed that ESRD patients on HD with HCV infection have higher Hb and HCT levels compared with HCV-negative patients.

The Effect of Hepatitis C Virus Infection on Insulin Resistance in Chronic Hemodialysis Patients

“…These results are in agreement with Tsai et al, [11] and can be due to replication of the HCV virus in bone marrow, splenic sequestration and immune mediated [14] . Hemoglobin was higher in group 1 and these results are in agreement with Alsaran et al, [15] and can be explained by that hepatic inflammation induces erythropoietin production by liver cells and also due to altered iron metabolism [16] . As regard metabolic profile of group 1 and group 2, there were no significant differences regarding serum creatinine, URR, serum calcium and serum phosphorous.…”

Iron Overload Is Associated With Oxidative Stress and Nutritional Immunity During Viral Infection in Fish

“…Interestingly, it has been documented that viral infection blocks the expression of Interferon as a strategy of immune evasion ( 39 ); however, it has also been reported that increase levels of Interferon correlate with viral replication ( 37 ), which is in agreement with our results. Experiments that have used cultured cells found that iron might increase the expression of virus replication genes, possibly through its effects on translation via eukaryotic translation initiation factor 3, eIF-3 ( 40 , 41 ). Our results suggest that eIF-3 complex, which is required for several steps in the initiation of protein synthesis ( 42 ), also was highly modulated in headkidney of infected fish.…”

Impact of iatrogenic iron overload on the course of hepatitis C in the dialysis population: A plea for caution

“…Although several studies have shown that HCV‐infected hemodialysis patients may have higher hemoglobin, transferrin saturation and ferritin levels, and lower iron and erythropoiesis‐stimulating agent (ASE) requirements than dialysis patients without HCV infection, the recent DOPPS study showed that HCV infected dialysis patients have higher incidence of hemoglobin decline below 8.5 g/dL (HR: 1.12; 95% CI: 1.03 to 1.21), blood transfusion (HR: 1.36; 95% CI: 1.20 to 1.55) and of gastrointestinal bleeding (HR: 1.32; 95% CI: 1.13 to 1.54) as compared to non‐HCV dialysis patients, pointing to the deleterious effect of their liver disease on anemia …”