title: Factors associated with the progression of hepatic fibrosis in end-stage kidney disease patients with hepatitis C virus infection.
abstract: BACKGROUND
  Few studies have evaluated the histological aspects of hepatitis C virus (HCV) infection in hemodialysis patients and the factors related to the progression of hepatic fibrosis in this population have not been defined.
  
  
  OBJECTIVE
  To evaluate the influence of host-related factors on the fibrosis progression in end-stage renal disease (ESRD) patients with HCV infection.
  
  
  METHODS
  HCV-infected ESRD patients who submitted to liver biopsy were included. The fibrosis stages were classified according to METAVIR scoring system. For the identification of factors associated with more advanced liver fibrosis, the patients were classified into two groups: group 1, absence of septal fibrosis (F0-1) and group 2, presence of septal fibrosis (F2-4). Groups 1 and 2 were compared regarding demographic, epidemiological, and laboratory variables and logistic regression analysis was used to identify the variables that were independently associated with the presence of septal fibrosis.
  
  
  RESULTS
  A total of 216 ESRD patients (63% men, 44+/-11 years) were included. In the histological analysis, the fibrosis stages were as follows: F0=36%, F1=41%, F2=12%, F3=7, and 4% had cirrhosis (F4). In the logistic regression model, the variables that were independently associated with the presence of septal fibrosis were duration of infection, estimated age at infection, coinfection with HBV and aspartate aminotransferase levels.
  
  
  CONCLUSIONS
  These findings support the importance of obtaining an adequate immune response to HBV vaccination and careful monitoring of liver disease in patients who become infected at an advanced age and/or those presenting elevated aspartate aminotransferase levels, as these are the main factors associated with the presence of septal fibrosis in ESRD patients.
authors.affiliation: Division of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Vitória R
authors.initials: VR
authors.lastname: Becker
authors.forename: Rosilene G
authors.initials: RG
authors.lastname: Badiani
authors.forename: Lara B
authors.initials: LB
authors.lastname: Lemos
authors.forename: Renata M
authors.initials: RM
authors.lastname: Perez
authors.forename: José O
authors.initials: JO
authors.lastname: Medina-Pestana
authors.forename: Valeria P
authors.initials: VP
authors.lastname: Lanzoni
authors.forename: Adalgisa P
authors.initials: AP
authors.lastname: Ferreira
authors.forename: Antonio Eduardo B
authors.initials: AE
authors.lastname: Silva
authors.forename: Maria Lucia G
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors