Clinical presentation of chronic hepatitis C in patients with end-stage renal disease and on hemodialysis versus those with normal renal function.
BACKGROUND
The natural history of chronic hepatitis C (CHC) remains to be defined in patients with end-stage renal disease (ESRD).


OBJECTIVE
To determine the clinical presentation of CHC and the factors associated with stage III-IV fibrosis in patients with CHC and ESRD.


METHODS
The study included patients with CHC and ESRD (n = 91) or normal renal function (NRF, n = 159). Both groups were matched for mean age, gender, history of alcohol use, and estimated duration of hepatitis C virus (HCV) infection.


RESULTS
Presentation of CHC and ESRD was independently associated with non-Caucasian ethnicity (OR = 3.24, p= 0.0003), a history of diabetes mellitus (DM, OR = 7.911, p < 0.0001), and lower frequencies of being obese (OR = 0.457, p= 0.035), of having hepatic steatosis (OR = 0.372, p= 0.003), and stage III-IV fibrosis (OR = 0.403, p= 0.016). After adjusting for serum levels of alpha-fetoprotein (AFP) and HCV RNA, CHC, and ESRD were independently associated with lower frequencies of elevated alanine aminotransferase (ALT, OR = 0.175, p= 0.02) and aspartate aminotransferase (AST, OR = 0.169, p= 0.04), but higher frequencies of AST/ALT ratio >1 (OR = 7.173, p= 0.002) and hypoalbuminemia (OR = 9.567, p= 0.0007). Compared to patients with NRF and stage III-IV fibrosis, those with ESRD and stage III-IV fibrosis had a significantly higher frequency of a history of DM (OR = 8.014, p= 0.0031) and lower frequency of elevated AST (OR = 0.054, p= 0.004), which were independent of the frequencies of lower levels of ALT and albumin, and AST/ALT ratio >1. In patients with CHC and ESRD, the presence of stage III-IV fibrosis was significantly associated with hepatic steatosis (OR = 4.523, p= 0.012) and thrombocytopenia (OR = 4.884, p= 0.044), which were independent of the frequencies of a history of DM, splenomegaly, and a higher level of AST.


CONCLUSIONS
CHC and ESRD are independently associated with a higher frequency of a history of DM, but lower frequencies of being obese, and having hepatic steatosis, stage III-IV fibrosis, and elevated transaminases. In patients with CHC and ESRD, stage III-IV fibrosis is not associated with a history of DM, but is independently associated with hepatic steatosis and thrombocytopenia.
Hu
Ke-Qin
KQ
Division of Gastroenterology and Hepatology, University of California, Irvine Medical Center, Orange, California 92868, USA.
Lee
Steve M
SM
Hu
Shirley X
SX
Xia
Victor W
VW
Hillebrand
Donald J
DJ
Kyulo
Namgyal L
NL
D000428:Alcohol Drinking; D048909:Diabetes Complications; D005234:Fatty Liver / Q000150:complications; D005260:Female; D005355:Fibrosis / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D006435:Renal Dialysis; D013921:Thrombocytopenia / Q000150:complications; D000637:Transaminases / Q000097:blood
D000637:Transaminases