Effect of HCV infection on hematocrit and hemoglobin level in Egyptian hemodialysis patients

Abstract

The prevalence of HCV infection in patients undergoing dialysis is persistently greater than that in the general population [1]. It is endemic in hemodialysis (HD) units around the world, predominantly in Mediterranean and developing countries of the Middle and Far East. Nosocomial transmission of HCV has been reported to be the major route of HCV infection in modern hospital dialysis units. Anemia is the most common hematological abnormality in chronic renal failure. In the past, blood transfusion was the essential method in the treatment of renal anemia, whereas the transfusion requirement has recently lessened by the use of erythropoietin (EPO). It is known that there is a relationship between iron stores and HCV infection. However, the influence of HCV infection upon potential iron and erythropoietin therapy is controversial. High serum ferritin level and hepatosteatosis are frequently seen among patients with HCV infection. However, it is not clear whether HCV infection causes iron accumulation or increased iron storage facilitates HCV infection. Erythropoietin requirements and levels in patients with HCV positive (+) and HCV negative (-) was reported to be different in patients with ESRD. In view of the recently published data reporting higher hemoglobin and hematocrit levels in HCV+ compared to HCVHD patients, we decided to compare these values in our patients. Ninety-nine patients (68 male, 31 female, mean age 42.81 ± 16.63 years, 70 patients were HCV+ and 29 were HCV-) receiving chronic hemodialysis for at least one year in Mansoura Urology and Nephrology Center hemodialysis units were retrospectively studied (The Demographic, clinical and laboratory parameters are given in Table 1). AntiHCV determinations were performed in all patients by third generation enzyme—linked immunosorbent assay. HCVRNA was confirmed in all positive patients by nested polymerase chain rection (PCR) carrid out with primers located with the 5‘NC region of HCV-genome (Amplicor, Roche, Branchburg, NJ, USA) and repeated every 3 months. Anti-HCV antibodies, Hepatitis B surface antigen and antibody and antibodies to Human Immunodeficiency virus 1 and 2 were done on quarterly bases. All patients were subjected to monthly biochemical analysis—samples were withdrawn from the patients before hemodialysis—for: Serum sodium, potassium, uric acid, fasting blood sugar, uric acid, cholesterol, triglycerides, liver function test and complete blood count. A. A.-A. Sabry (&) K. F. El-Dahshan K. M. Mahmoud A. A El-Husseini Nephrology and Internal Medicine Department, Mansoura University, Mansoura Al Ghomhoria, 35555, Egypt e-mail: asabry20@yahoo.com