title: Hepatitis C among predialysis patients: prevalence and characteristics in a large cohort of patients.
abstract: BACKGROUND
  The factors associated with hepatitis C virus (HCV) infection in predialysis patients need to be better investigated. The aims of this study were to evaluate the prevalence, risk factors, clinical, biochemical and virological characteristics of chronic HCV infection in predialysis patients.
  
  
  METHODS
  Anti-HCV antibodies were determined in a large cohort of predialysis patients. Epidemiological and laboratorial characteristics of HCV infection were evaluated in predialysis patients and this group was matched to a control group consisting of predialysis patients without viral infection (1:3) and compared in terms of risk factors and alanine aminotransferase (ALT) levels. Logistic regression analysis was applied to identify variables independently associated with chronic HCV infection.
  
  
  RESULTS
  A total of 1,041 patients (61% males) with a mean age of 61 +/- 15 years and mean creatinine clearance of 36 +/- 18 ml/min were included. Forty-one (3.9%) patients were anti-HCV positive and, of these, 39 (95%) presented viremia. Predialysis patients with HCV more frequently showed a history of blood transfusion before 1992 (66.7 vs. 10.3%; p < 0.001) and major surgeries (53.8 vs. 17.1%; p < 0.001), a higher proportion of undetermined etiology of kidney disease (43.6 vs. 17.1%; p = 0.001), and higher ALT levels (1.3 vs. 0.4 xULN; p < 0.001). History of blood transfusion before 1992 (p < 0.001; OR: 19), intravenous drug abuse (p = 0.002; OR: 69) and ALT levels (p < 0.001; OR: 50) were the variables that were independently associated with chronic HCV infection. The accuracy of ALT in detecting HCV infection was 92%. The most prevalent HCV genotype was 1b (48.7%) and 56.5% of patients presented high HCV viral load.
  
  
  CONCLUSIONS
  Chronic HCV infection among predialysis patients is related to increased parenteral exposure. Elevated ALT levels suggest the need for HCV screening as part of the predialysis care since ALT seems to be a good marker of this infection.
authors.affiliation: Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Lara B
authors.initials: LB
authors.lastname: Lemos
authors.forename: Renata M
authors.initials: RM
authors.lastname: Perez
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Lemos
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Draibe
authors.forename: Ivonete S
authors.initials: IS
authors.lastname: Silva
authors.forename: Antonio Eduardo B
authors.initials: AE
authors.lastname: Silva
authors.forename: Maria Lucia G
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy* / Q000821:virology*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011336:Probability; D012367:RNA, Viral / Q000032:analysis; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D012367:RNA, Viral