title: Hepatitis C Virus Infection in Patients with End-Stage Renal Disease: A Study from a Tertiary Care Centre in India.
abstract: BACKGROUND
  Hepatitis C Virus (HCV) infection is common in patients with end stage renal disease (ESRD) and is an important cause of liver disease. We describe the demographic, clinical and biochemical profile of these patients from a tertiary care center of north India.
  
  
  METHODS
  Records of consecutive patients of HCV infection with ESRD on maintenance hemodialysis or with renal transplantation who presented to our unit from January 2009 to June 2013 were analyzed. The diagnosis of HCV was based on HCV-RNA positivity and/or positive anti-HCV serology. Those with positive anti-HCV serology and negative HCV-RNA on two occasions at 3-month interval, without treatment with interferon, were excluded.
  
  
  RESULTS
  140 patients (median age 44 years [range 18-68], 69% males) were included. Six patients had co-infections (HBV 5, HIV 1). Most (99, 71%) patients were asymptomatic for liver disease and HCV was identified either on routine screening (39, 28%) or during investigation for raised liver enzymes (60, 43%). Remaining 41 (29%) were symptomatic for liver disease, either in the form of jaundice alone (14, 10%), or decompensated liver disease (27, 19%). Median time between initiation of hemodialysis and HCV detection was 33 (range 0-124) months. Thirty-four (27%) patients had received renal transplantation. In 11 patients HCV was detected after renal transplantation. In 23 (18%) patients anti-HCV was falsely negative but HCV-RNA was positive. Nearly 35% patients had concomitant diabetes. Median Bilirubin, AST, and ALT were 1.1 mg/dL, 42 IU/L and 44 IU/L, respectively. HCV-RNA was more than 5 log in 49/88(59%) patients. Median HCV-RNA was 6.5 × 10(5) IU/ml (Range 650 to >10 million IU/ml). Genotype-1 was the commonest genotype (30/56, 54%) followed by genotype-3 (17/56, 30%).
  
  
  CONCLUSIONS
  HCV infection is usually asymptomatic in patients with ESRD, however, it may lead to jaundice and decompensated liver disease. False negative anti-HCV is quite common. We found that genotype-1 was commoner than genotype-3 in our cohort of ESRD patients. Most of the patients have high viral load.
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singla
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Tyagi
authors.affiliation: Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Malik
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
keywords: ACLF, acute-on-chronic liver failure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ESRD; ESRD, end stage renal disease; GI, gastrointestinal; HCC, hepatocellular carcinoma; HCV; HCV, hepatitis C virus; Hb, hemoglobin; INR, international normalized ratio; PT, prothrombin time; RNA, ribonucleic acid; RT, renal transplantation; USG, ultrasonography; genotype; hemodialysis; renal transplant