Nephrology Dialysis Transplantation, Vol 12, Issue 7 1394-1398, Copyright © 1997 by Oxford University Press
F Fabrizi, G Lunghi, S Andrulli, B Pagliari, S Mangano, P Faranna, A Pagano and F Locatelli
BACKGROUND: There are many reports concerning HCV in dialysis patients and
most of them conclude that the clinical and biochemical features of
hepatitis C are often silent in chronic dialysis patients. Elevated levels
of serum alanine aminotransferase activity are a sensitive measure of
hepatocellular injury, but so far the relationship between anti-HCV and ALT
among chronic dialysis patients has been considered imperfect. To our
knowledge, however, such an issue has not been adequately addressed.
METHODS: Demographic, biochemical, and virological data from 506 patients
undergoing chronic dialysis treatment in four dialysis units in Lombardy,
northern Italy were collected in order to assess the influence of
virological and host factors on serum aminotransferase values. RESULTS:
Analysis of covariance showed that positivity for anti-HCV antibody was
significantly associated with raised serum AST (P = 0.0001) and ALT (P =
0.0001) levels in the dialysis patients of the whole study group. Logistic
regression analysis performed in the subset of patients tested for HCV
viraemia and genotype showed that detectable HCV RNA in serum is a strong
predictor of raised AST (P = 0.0001) and ALT (P = 0.000001) values. Gender
showed an independent weak influence on AST levels (P = 0.055), serum
levels of ferritin were significantly (P = 0.042) associated with AST
values, the coexistence of HBsAg infection and positivity for anti-HCV
antibody was independently associated with raised ALT levels (P = 0.016).
The other factors (including positivity for anti-HCV) showed no independent
effect on serum aminotransferase levels when they were matched with HCV
viraemia in our multivariate analysis. HCV RNA positive patients showed
serum AST (P < 0.008) and ALT levels (P < 0.0001) higher than HCV RNA
negative patients. There was no relationship between HCV genotypes and
liver enzymes. CONCLUSIONS: Our data show that detectable HCV RNA in serum
is a strong independent predictor of raised aminotransferase values in
chronic dialysis patients; the relationship between serum aminotransferase
values and anti-HCV antibody was exclusively related to the association
between raised aminotransferase values and HCV viraemia; HCV RNA positive
patients show higher hepatic enzyme levels than dialysis patients with no
detectable HCV RNA; no association between HCV genotype and serum
aminotransferase activity was apparent.
ORIGINAL ARTICLES
Influence of hepatitis C virus (HCV) viraemia upon serum aminotransferase activity in chronic dialysis patients
Nephrology and Dialysis Division, Hospital, Lecco, Italy.
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