Title: Does Hepatitis C Affect Hematological Parameters, Co Morbidity And Functional Status In Hemodialysis Pateints?
Authors: Ahmed Ramadan, Hesham Abouellail, Sahar Shawky, Sameh Abdelraouf
DOI: http://dx.doi.org/10.18535/jmscr/v4i6.59
Objectives: Hepatitis C is a serious public health problem throughout the world; chronic renal patients are highly exposed to this infection. As a chronic disease it will affect all body systems, the present study investigated the effect of HCV infection on hematologic parameters, comorbidities & functional statusin the hemodialysis population in our outpatient hemodialysis unit and how much extend of Epo & Iron requirement in these patients over 6 months of study. Patients and Methods: the hematological parameters were assessed in 63 hemodialysis patients after their consents on regular thrice weekly hemodialysis schedules for at least 6 months, divided into two groups according to Hepatitis C virus screening by antibodies and HCV - RNA PCR(23 patients with HCV +ve,12 males & 11 females, and 40 patients HCV –ve,24 females& 16 males as a control group of age-matched, race-matched, and gender-matched). Exclusion criteria included polycystic kidney disease, cryoglobulinemia, hepatitis B, active malignancy, hematopoietic disorders (including multiple myeloma), chronic infections (including osteomyelitis), those with any massive blood loss or history of blood transfusion,, liver cell failure, active treatment with interferon and or ribavirin and the presence of mass or multiple cysts on renal ultrasound. Patients had to be stable on hemodialysis for at least 6 months with a urea reduction ratio (URR)>65% and demonstrate compliance with fewer than 3 missed dialysis sessions per month. All the patients were subjected to: Detailed medical history, clinical examination and monthly laboratory tests to evaluate liver function tests and hematological parameters (serum Albumin, Alanine Aminotransferase (ALT), iron, Transferrin saturation % (TRFS %) and Hemoglobin(HB).Their requirements of erythropoietin (EPO- beta, Mircera) and intravenous (IV) iron (Ferric Carboxymaltose, FerinJect) were assessed during these 6 months of clinical stability. the comorbidities and the functional status were assessed by using Index of Coexisting Diseases (ICED)& Karnofsky Index (KI) Results: Both groups were able to achieve adequate blood hemoglobin (HB) above 11 gm/dl, serum iron and transferring saturation (TRFS %) between 20-50 % according to KDOGJ guidelines, there was significant higher serum level regarding HB&, iron at zero, 3 and 6 months (P<0.05) in HCV +ve group than negative group, and also HCV +ve patients showed statistically highly significant difference in TRFS% in comparison with HCV –ve cases (P<0.001).. Regarding liver parameters HCV +ve cases showed higher levels of ALT only at 6 months samples (P < 0.05) & higher levels of serum albumin in all studied but achieved the statistically high significant level only at 3 months(P<0.05)).In HCV +ve group, there was no statistically significant difference in blood HB and serum iron (P>0.05) when compared with the started study levels by 3 and 6 months levels respectively (P>0.05) but TRFS% showed statistically high significant difference (P<0.001) when compared the started by 3 months and 6 months levels respectively, serum ALT and serum Albumin show stable levels and there were no significant changes during the period of the study (P>0.05). The exogenous EPO-beta requirement of patients with HCV +ve was overall significantly lower even when adjusted for body weight ( the total dose of Epo- beta, Mircera was lower in HCV +ve patients of 718.3 ± 58.3 ug than HCV –ve of 1937 ± 400 ug / 6 months ,p < 0.001 ).and also the total dose of IV Iron , Ferin Ject at 6 months was lower in positive group than the control,1.117±0.23 and 2.5 ±0.64 gm respectively p < 0.001. No statistics difference between both groups regarding the comorbidities using the Index of Coexisting Diseases (ICED) & functional status by KI index, P > 0.05 Conclusion: So we concluded that Hepatitis C positive patients tend to have higher baseline hemoglobin, serumiron, serum TRFS % and decreased need for EPO & IV Iron therapy on dialysis ,but we study only stable compensate HCV +ve without viral activity. The possible explanation for these findings may be the release of hepatic EPO because of chronic hepatic inflammation secondary to HCV; further studies needed in decompensated HCV for more data. Keywords: hemodialysis, hepatitis C, hematological parameters, IV Epo, IV Iron co morbidities (ICED), Functional Index ( KI ).
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