title: Dialysis reduces portal pressure in patients with chronic hepatitis C.
abstract: The purpose of this study was to characterize changes in hepatic venous pressures in patients with chronic hepatitis C. The histology and laboratory data from patients with chronic hepatitis C who underwent a transjugular liver biopsy (TJLB) and hepatic venous pressure gradient measurement were analyzed. Portal hypertension was defined as hepatic venous pressure gradient > or =6 mm Hg. A single pathologist masked to hepatic venous pressure gradient scored liver sections for inflammation and fibrosis. The patients with high-grade inflammation (relative risk [RR] 2.82, P = 0.027, multivariate analysis) and late-stage fibrosis (RR 2.81, P = 0.022) were more likely to have a hepatic venous pressure gradient > or =6 mm Hg, while the patients on dialysis (RR 0.32, P = 0.01) were less likely to have a hepatic venous pressure gradient > or =6 mm Hg. The patients on dialysis (n = 58) had an elevated serum blood urea nitrogen and creatinine when compared with those who were not (n = 75) (47.6 +/- 3.3 and 7.98 +/- 0.4 vs. 25.9 +/- 2.0 and 1.66 +/- 0.22 mg/dL, respectively; P < 0.001). While the hepatic venous pressure gradient increased with the rising levels of liver fibrosis in the latter group (P < 0.01), it did not change in the patients on dialysis (P = 0.41). The median hepatic venous pressure gradient was especially low in late-stage fibrosis patients on dialysis when compared with the latter group (5 vs. 10 mm Hg, P = 0.017). In patients on dialysis, serum transaminases were low across all levels of fibrosis. Twenty-three of the 92 patients with early fibrosis had a hepatic venous pressure gradient > or =6 mm Hg. In patients with chronic hepatitis C, concomitant TJLB and hepatic venous pressure gradient measurement identify those who have early fibrosis and portal hypertension. Long-term hemodialysis may reduce portal pressure in these patients.
authors.affiliation: Division of Gastroenterology and Hepatology, VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore, MD 21201, USA. skhurana@medicine.umaryland.edu
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khurana
authors.forename: Thomas
authors.initials: T
authors.lastname: Simcox
authors.forename: William
authors.initials: W
authors.lastname: Twaddell
authors.forename: Cinthia
authors.initials: C
authors.lastname: Drachenberg
authors.forename: Mark
authors.initials: M
authors.lastname: Flasar
mesh_terms: D019698:Hepatitis C, Chronic / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000473:pathology / Q000503:physiopathology; D017082:Portal Pressure; D006435:Renal Dialysis