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Liver disease in dialysis patients with antibodies to hepatitis C virus
J al-Wakeel1, G H Malik, S al-Mohaya
1Division of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia.
Insights
Hepatitis C virus (HCV) infection is prevalent in dialysis patients. Liver biopsy is crucial for assessing liver disease severity in these patients, as biochemical tests are unreliable indicators.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Chronic end-stage renal failure (ESRF) patients on dialysis are at risk for viral infections.
- Hepatitis C virus (HCV) is a significant concern in this vulnerable population.
- Assessing liver health in ESRF patients requires accurate diagnostic methods.
Purpose of the Study:
- To evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) antibodies in ESRF patients.
- To assess the correlation between biochemical markers and histopathological findings of liver disease in HCV-positive dialysis patients.
- To determine the utility of liver biopsy in diagnosing and prognosing liver disease in this cohort.
Main Methods:
- Eighty-three ESRF patients (65 on hemodialysis, 18 on peritoneal dialysis) were screened for HBV and HCV antibodies.
- HCV-positive patients underwent liver biopsy for histopathological examination.
- Blood transfusion history, HIV status, and liver enzymes were recorded.
Main Results:
- Nineteen patients tested positive for HCV antibodies; 11 acquired infection during dialysis.
- Liver biopsy revealed various histopathological lesions, including chronic active hepatitis, chronic persistent hepatitis, and cirrhosis.
- No correlation was found between biochemical liver enzyme levels and histopathological findings; some patients with normal enzymes had abnormal histology.
- HCV infection was less common in peritoneal dialysis patients.
- Four anti-HCV positive patients without blood transfusions showed milder liver disease.
Conclusions:
- Biochemical tests are poor indicators of liver disease in dialysis patients with HCV antibodies.
- Liver biopsy is a definitive tool for evaluating liver disease severity and prognosis in HCV-positive ESRF patients.
- Early detection and monitoring of HCV infection are critical for managing liver health in dialysis populations.
Abstract:
Eighty-three patients with chronic end-stage renal failure, including 65 on haemodialysis and 18 on intermittent peritoneal dialysis, were evaluated for hepatitis B virus profile and antibodies to hepatitis C virus (HCV). All those positive for HBsAg were excluded from the study. Nineteen patients were found to be positive for antibodies to HCV by the ELISA II test. Eight cases were already positive for HCV antibody when they started dialysis in our unit, the other 11 became positive during dialysis in our unit. Only one of the patients on peritoneal dialysis was positive for HCV. A liver biopsy was obtained from 17 patients, who consented to the procedure. All the cases were evaluated for the number of blood transfusions received, HIV infection and the approximate time of contracting the HCV infection. Liver enzymes were determined every month. Only three patients had abnormally raised serum aminotransferase at the time of biopsy. The various histopathological lesions detected were chronic active hepatitis (n = 3, including one with changes consistent with cirrhosis), chronic persistent hepatitis (n = 4), non-specific hepatitis (n = 3) and haemosiderosis (n = 3); four biopsy samples were normal. There was no correlation between the biochemical and histopathological changes. Moreover, patients with normal serum aminotransferase levels had abnormal histopathological changes. All were negative for HIV and none of the patients had received a renal graft. Twelve patients had received blood transfusions varying from 2 to 12 units, four had not received any blood, and in one the history of blood transfusion could not be confirmed. The four patients with anti-HCV antibodies who had not received blood transfusion had relatively mild disease--non-specific hepatitis (n = 2) or normal biopsy (n = 2). One patient with cirrhosis died 30 months after liver biopsy from hepatic insufficiency and three received renal transplants. Others are continuing on dialysis and their biochemical tests are within normal limits 12-45 (30 +/- 14) months after biopsy. In conclusion, biochemical tests are poor indicators of liver disease, and liver biopsy is a definitive way of evaluating the patients of dialysis with positive HCV antibodies for prognosis.