Liver fibrosis of hepatitis C virus infection in routine hemodialysis patients in Indonesia
DOI:
https://doi.org/10.13181/mji.v28i4.3776Keywords:
hemodialysis, hepatitis C, liver fibrosisAbstract
BACKGROUND The risk of hepatitis C virus (HCV) infection is increasing in patients under routine hemodialysis, but only some patients progress to liver fibrosis. This study was aimed to identify the prevalence of significant liver fibrosis in routine hemodialysis patients with hepatitis C infection as well as factors associated with liver fibrosis.
METHODS This cross-sectional study was conducted in three tertiary general hospitals (Cipto Mangunkusumo Hospital, Persahabatan Hospital, and Fatmawati Hospital) in Jakarta, Indonesia, among hemodialysis patients infected with HCV. Total sampling was used from May to September 2017 in hemodialysis unit of all hospitals. Sex, age, time at first diagnosis of HCV, duration of HCV infection, duration of hemodialysis, AST level, hepatitis B virus coinfection and diabetes mellitus were analyzed in association with significant liver fibrosis. Liver fibrosis was assessed using transient elastography and considered significant if the value was ≥7.1 kPa. Chi-square, Mann–Whitney U, and Fisher's exact tests were used. Risk model was analyzed with logistic regression.
RESULTS Of the 133 hemodialysis patients infected with HCV, 71.4% of the subjects had significant liver fibrosis. In the risk model, male gender (odds ratio [OR] = 3.92; 95% confidence interval [CI] = 1.74–8.84; p < 0.001) and diabetes mellitus (DM) (OR = 2.85; 95% CI = 1.03–7.88; p = 0.043) were associated with significant liver fibrosis.
CONCLUSIONS The prevalence of significant liver fibrosis in routine hemodialysis patients with hepatitis C infection was high. Male and DM were associated with significant liver fibrosis.
Downloads
References
Ramachandran P, Iredale JP. Reversibility of liver fibrosis. Ann Hepatol. 2009;8(4):283-91. https://doi.org/10.1016/S1665-2681(19)31740-5
Rakela J, Vargas HE. Hepatitis C: magnitude of the problem. Liver Transpl. 2002;8(10 Suppl 1):S3-6. https://doi.org/10.1053/jlts.2002.35855
Sherman KE. Advanced liver disease: what every hepatitis C virus treater should know. Top Antivir Med. 2011;19(3):121-5.
Tovo CV, Becker SC, Almeida PR, Galperim B, Chaves S. Progression of liver fibrosis in monoinfected patients by hepatitis C virus and coninfected by HCV and human immunodeficiency virus. Arq Gastroenterol. 2013;50(1):19-22. https://doi.org/10.1590/S0004-28032013000100005
Ramzi ZS, Abdulla AA, Al-Hadithi T, Al-Tawil N. Prevalence and risk factors for hepatitis C virus infection in hemodialysis patients in Sulaimani. Zanco J Med Sci. 2010;14(1):44-50.
Lee JW. Renal dysfunction in patients with chronic liver disease. Electrolyte Blood Press. 2009;7(2):42-50. https://doi.org/10.5049/EBP.2009.7.2.42
Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in haemodialysis: the 'no-isolation' policy should not be generalized. Nephron Clin Pract. 2009;111(2):c133-40. https://doi.org/10.1159/000191208
Fabrizi F, Dixit V, Messa P. Impact of hepatitis C on survival in dialysis patients: a link with cardiovascular mortality? J Viral Hepat. 2012;19(9):601-7. https://doi.org/10.1111/j.1365-2893.2012.01633.x
Ladino M, Pedraza F, Roth D. Hepatitis C virus infection in chronic kidney disease. J Am Soc Nephrol. 2016;27(8):2238-46. https://doi.org/10.1681/ASN.2016010030
Lee MH, Yang HI, Lu SN, Jen CL, You SL, Wang LY, et al. Chronic hepatitis C virus infection increases mortality from hepatic and extrahepatic diseases: a community-based long-term prospective study. J Infect Dis. 2012;206(4):496-77. https://doi.org/10.1093/infdis/jis385
Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group. KDIGO 2018 clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2018;8:91-165. https://doi.org/10.1016/j.kisu.2018.06.001
Oliveira AC, Bortotti AC, Nunes NN, El Bacha IA, Parise ER. Association between age at diagnosis and degree of liver injury in hepatitis C. Braz J Infect Dis. 2014;18(5):507-11. https://doi.org/10.1016/j.bjid.2014.04.003
Ceylan B, Yardimci C, Fincanci M, Tözalgan Ü, Eren G, Müderriso?lu C, et al. Predictors of liver fibrosis in patients with chronic HCV Infection. Turkiye Klinikleri J Med Sci. 2012;32(6):1522-9. https://doi.org/10.5336/medsci.2011-25802
Dienstag JL, Ghany MG, Morgan TR, Di Bisceglie AM, Bonkovsky HL, Kim HY, et al. A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. Hepatology. 2011;54(2):396-405. https://doi.org/10.1002/hep.24370
Negro F, Alaei M. Hepatitis C virus and type 2 diabetes. World J Gastroenterol. 2009;15(13):1537-47. https://doi.org/10.3748/wjg.15.1537
Becker VR, Badiani RG, Lemos LB, Perez RM, Medina-Pestana JO, Lanzoni VP, et al. Factors associated with the progression of hepatic fibrosis in end-stage kidney disease patients with hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2009;21(12):1395-9. https://doi.org/10.1097/MEG.0b013e328313bbc1
Agarwal SK, Gupta SD. Liver biopsy in patients on hemodialysis with hepatitis C virus infection. Indian J Nephrol. 2015;25(3):152-7. https://doi.org/10.4103/0971-4065.139097
Elvírez-Gutiérrez Á, Castellanos-Fernández MI, Santillán-López W, Dorta-Guridi Z, Galbán-García E, Arús-Soler E. Liver stiffness reference values for healthy Cuban adults. Medicc Rev. 2018;20(1):24-8.
Shimizu I, Mizobuchi Y, Yasuda M, Shiba M, Ma YR, Horie T, et al. Inhibitory effect of estradiol on activation of rat hepatic stellate cells in vivo and in vitro. Gut. 1999;44(1):127-36. https://doi.org/10.1136/gut.44.1.127
Santoro D, Mazzaglia G, Savica V, Li Vecchi M, Bellinghieri G. Hepatitis status and mortality in hemodialysis population. Ren Fail. 2009;31(1):6-12. https://doi.org/10.1080/08860220802546289
Zayed BEM, Elsharkawy A, Abdou M, Abd Al Fatah DS, El- Shabony TH. Assessment of hepatic fibrosis by fibroscan in Egyptian chronic hemodialysis patients with chronic hepatitis C (genotype 4): a single-center study. Saudi J Kidney Dis Transpl. 2017;28(4):764-73.
Sagnelli E, Coppola N, Scolastico C, Filippini P, Santantonio T, Stroffolini T, et al. Virologic and clinical expressions of reciprocal inhibitory effect of hepatitis B, C, and delta viruses in patients with chronic hepatitis. Hepatology. 2000;32(5):1106-10. https://doi.org/10.1053/jhep.2000.19288
Caccamo G, Saffioti F, and Raimondo G. Hepatitis B virus and hepatitis C virus dual infection. World J Gastroenterol. 2014;20(40):14559-67. https://doi.org/10.3748/wjg.v20.i40.14559
Huang YW, Yang SS, Fu SC, Wang TC, Hsu CK, Chen DS, et al. Increased risk of cirrhosis and Its decompensation in chronic hepatitis C patients with new-onset diabetes: a nationwide cohort study. Hepatology. 2014;60(3):807-14. https://doi.org/10.1002/hep.27212
Mohamed WZ. Prevention of hepatitis C virus in hemodialysis patients: five years experience from a single center. Saudi J Kidney Dis Transpl 2010;21(3):548-54.
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
