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Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

Jose Eduardo Trevizoli^*, Raissa de Paula Menezes, Lara Franciele Ribeiro Velasco, Regina Amorim, Mauro Birche de Carvalho, Liliana Sampaio Mendes, Columbano Junqueira Neto, José Roberto de Deus Macedo^||, Francisco de Assis^¶, and Rocha Neves^¶

^* Hospital de Base do Distrito Federal, Secretaria de Estado de Saúde (SES), Brasília, DF, Brazil; and Universidade Católica de Brasília, Brasília, DF, Brazil; Hospital de Base do Distrito Federal, SES, Brasília, DF, Brazil; Sabin Institute and Laboratory of Clinical Analysis, Brasília, DF, Brazil; Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil; ^|| Hospital Santa Luzia, Brasília, DF, Brazil; and ^¶ Laboratório de Farmacologia Molecular, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil

Correspondence: Dr. José Eduardo Trevizoli, SQS 111, Bloco D, Apartamento 403, CEP 70374-040, Brasília, DF, Brazil. Phone: +55-61-3245-3166; Fax: +55-61-3445-1402; E-mail: jetrevizoli{at}terra.com.br; or Prof. Francisco de Assis Rocha Neves, Laboratório de Farmacologia Molecular, Faculdade de Ciências da Saúde, Universidade de Brasília, CEP 70910-900, Brasília, DF, Brazil. Phone: +55-61-33072098; Fax: 55-61-33474622; E-mail: chico{at}unb.br

Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function.

Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection.

Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001).

Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV.