title: Different kinetics of HBV and HCV during haemodialysis and absence of seronegative viral hepatitis in patients with end-stage renal disease.
abstract: BACKGROUND
  Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are common in haemodialysis units. Moreover, some studies reported seronegative cases of viral hepatitis. We and others have previously shown an HCV RNA decline during haemodialysis; however, limited data on HBV viraemia during haemodialysis are available.
  
  
  METHODS
  A total of 142 haemodialysis patients participated in this study, 11 were anti-HCV positive and 7 were HBsAg positive. HCV RNA and HBV DNA were determined in all patients irrespective of hepatitis serology. HBV DNA, HCV RNA, HBsAg and HCV core antigen (HCVcoreAg) were quantified repeatedly in anti-HCV- and HBsAg-positive patients before and after haemodialysis.
  
  
  RESULTS
  No case of seronegative viral hepatitis could be identified. HCV RNA was detected in 9 of the 11 anti-HCV-positive patients, while HBV DNA tested positive in all 7 HBsAg-positive patients. A decrease of HCVcoreAg was observed during four dialysis sessions in 8/9 patients (-24.4 ± 22.7%, P < 0.001) parallelled by HCV RNA decline in most individuals (-10.1 ± 48.6%, P = 0.22). In contrast, HBV DNA and HBsAg declined only in 1/7 patients during all four independent measurements. The remaining six patients showed heterogeneous patterns of HBV DNA and HBsAg before and after haemodialysis without a significant change in mean HBV DNA and HBsAg levels (+14 ± 60.6% and -0.2 ± 25.3%, P > 0.05, respectively). HCVcoreAg correlated strongly with HCV RNA (r = 0.937; P < 0.001, n = 72), while there was no correlation between HBV DNA and HBsAg (r = -0.234; P = 0.131, n = 43).
  
  
  CONCLUSIONS
  Seronegative viral hepatitis is rare in German maintenance haemodialysis patients. HCV RNA and HCVcoreAg decline during haemodialysis indicating a potential beneficial effect of haemodialysis during antiviral therapy of hepatitis C, which does not apply to HBV infection.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, D-30625 Hannover, Germany. mederacke.ingmar@mh-hannover.de
authors.forename: Ingmar
authors.initials: I
authors.lastname: Mederacke
authors.forename: Matthias
authors.initials: M
authors.lastname: Meier
authors.forename: Johann B
authors.initials: JB
authors.lastname: Lüth
authors.forename: Hans
authors.initials: H
authors.lastname: Schmidt-Gürtler
authors.forename: Regina
authors.initials: R
authors.lastname: Raupach
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Horn-Wichmann
authors.forename: Karsten
authors.initials: K
authors.lastname: Wursthorn
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colucci
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: Hans L
authors.initials: HL
authors.lastname: Tillmann
mesh_terms: D000368:Aged; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D006509:Hepatitis B / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000821:virology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy / Q000821:virology*; D007677:Kidney Function Tests; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012367:RNA, Viral / Q000235:genetics; D006435:Renal Dialysis / Q000009:adverse effects*; D015996:Survival Rate; D014766:Viremia
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral