Original Contribution
The American Journal of Gastroenterology (2005) 100, 2010–2018; doi:10.1111/j.1572-0241.2005.51938.x
Clinical Presentation of Chronic Hepatitis C in Patients with End-Stage Renal Disease and on Hemodialysis Versus Those with Normal Renal Function
Ke-Qin Hu MD1, Steve M Lee MD2, Shirley X Hu3, Victor W Xia MD4, Donald J Hillebrand MD5 and Namgyal L Kyulo MPH1
- 1Division of Gastroenterology and Hepatology, University of California, Irvine Medical Center, Orange, California;
- 2Department of Medicine, Loma Linda University, Loma Linda, California;
- 3Earl Warren College, University of California, San Diego, California;
- 4Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, California;
- 5Transplantation Institute and Division of Gastroenterology, Loma Linda University, Loma Linda, California
Correspondence: Ke-Qin Hu, MD,, Division of GI/Hepatology, University of California, Irvine 101 The City Drive, Building 53, Rm. 113, Orange, CA 92868
Received 10 December 2004; Revised 0000; Accepted 5 April 2005.
Abstract
BACKGROUND:
The natural history of chronic hepatitis C (CHC) remains to be defined in patients with end-stage renal disease (ESRD).
AIMS:
To determine the clinical presentation of CHC and the factors associated with stage III-IV fibrosis in patients with CHC and ESRD.
METHODS:
The study included patients with CHC and ESRD (n = 91) or normal renal function (NRF, n = 159). Both groups were matched for mean age, gender, history of alcohol use, and estimated duration of hepatitis C virus (HCV) infection.
RESULTS:
Presentation of CHC and ESRD was independently associated with non-Caucasian ethnicity (OR = 3.24, p= 0.0003), a history of diabetes mellitus (DM, OR = 7.911, p < 0.0001), and lower frequencies of being obese (OR = 0.457, p= 0.035), of having hepatic steatosis (OR = 0.372, p= 0.003), and stage III-IV fibrosis (OR = 0.403, p= 0.016). After adjusting for serum levels of alpha-fetoprotein (AFP) and HCV RNA, CHC, and ESRD were independently associated with lower frequencies of elevated alanine aminotransferase (ALT, OR = 0.175, p= 0.02) and aspartate aminotransferase (AST, OR = 0.169, p= 0.04), but higher frequencies of AST/ALT ratio >1 (OR = 7.173, p= 0.002) and hypoalbuminemia (OR = 9.567, p= 0.0007). Compared to patients with NRF and stage III-IV fibrosis, those with ESRD and stage III-IV fibrosis had a significantly higher frequency of a history of DM (OR = 8.014, p= 0.0031) and lower frequency of elevated AST (OR = 0.054, p= 0.004), which were independent of the frequencies of lower levels of ALT and albumin, and AST/ALT ratio >1. In patients with CHC and ESRD, the presence of stage III-IV fibrosis was significantly associated with hepatic steatosis (OR = 4.523, p= 0.012) and thrombocytopenia (OR = 4.884, p= 0.044), which were independent of the frequencies of a history of DM, splenomegaly, and a higher level of AST.
CONCLUSIONS:
CHC and ESRD are independently associated with a higher frequency of a history of DM, but lower frequencies of being obese, and having hepatic steatosis, stage III-IV fibrosis, and elevated transaminases. In patients with CHC and ESRD, stage III-IV fibrosis is not associated with a history of DM, but is independently associated with hepatic steatosis and thrombocytopenia.
