[Does long-term erythropoietin therapy influence the prevalence of serum markers of hepatitis B and C in haemodialysed uraemic patients?].
Haemodialysed patients are highly exposed to different virus infections namely hepatitis B (HBV) and C (HCV). Recently it was shown, that the use of recombinant human erythropoietin (rHuEPO) in haemodialysed patients with chronic renal failure (CRF) stimulates not only erythropoesis but also increases--in an indirect or direct manner--the humoral and cell--mediated immune defense. The aim of the present study was to determine the prevalence of HBV and HCV infection in haemodialysed patients with CRF and renal anaemia treated either with rHuEPO or with allogenic blood transfusions only. 32 patients with CRF and renal anaemia (haematocrit value below 28%) were included in this study at the early stage of the dialysis therapy (0 to 6 months from the first haemodialysis session). All patients were randomly allocated into two groups. The first one consisted of 15 haemodialysed patients treated with rHuEPO, the second group composed of 17 occasionally treated with blood transfusions (No-EPO group). In patients of both groups the following parameters were examined before (0) and after 3, 6, 9, 12 months of monitoring number of units blood transfused, hemoglobin concentration, serum levels of ferritin. Before the study (0) and after 6 and 12 months presence of antigen HBs (AgHBs), antibodies anti-HBc, anti-HBs, anti-HCV, DNA HBV and RNA HCV were examined. Before the study markers of HBV infection (DNA HBV and/or AgHBs and/or anti-HBc) were found in 46.7% of patients in EPO group and in 52.9% of patients in NO-EPO group respectively (NS). After six months of the study markers of HBV infection were present in 60% of patients in EPO group and in 76.5% of patients in No-EPO group (NS). After 12 months of dialysotherapy HBV infection markers were found in 66.7% patients in EPO group and in 76.5% of patients in No-EPO group (NS). Significantly higher prevalence of HBV infections were found after 6 and 12 months respectively in No-EPO group in comparison to the prestudy period (p < 0.05). At the beginning of the study markers of HCV infection (RNA HCV and/or anti-HCV) were present in 26.7% of patients in EPO group compared to 35.3% of patients in No-EPO group (NS). After 6 months of therapy markers of HCV infection were found in 26.7% of patients in EPO group and in 64.7% of patients in No-EPO group (p < 0.05). After 12 months of treatment markers of HCV infections were present in 40% of patients in EPO group and 76.5% of patients in No-EPO group (p < 0.05).ln patients of No-EPO group significantly higher prevalence of HCV infection ware found after 6 and 12 months of the follow-up compared to the prestudy period (p < 0.05 and p < 0.01 respectively).


CONCLUSIONS
Treatment of renal anaemia with rHuEPO contributes to the significant decrease in prevalence of HCV infection. Decrease of prevalence of HCV infection in haemodialysed patients with chronic renal failure treated with rHuEPO seems to be predominantly a result of the complete cessation of allogenic blood transfusion. Blood transfusions seem not to be the main cause of HBV transmission in haemodialysed patients.
Mesjasz
Jacek
J
Oddzial Nefrologiczny Szpitala Wojewódzkiego nr 4 w Bytomiu.
Wiecek
Andrzej
A
Gonciarz
Zbigniew
Z
Mazur
Włodzimierz
W
Kokot
Franciszek
F
D000328:Adult; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects* / Q000706:statistics & numerical data*; D013995:Time; D014511:Uremia / Q000453:epidemiology*
D011994:Recombinant Proteins; D004921:Erythropoietin