Increase Serum Tumor Necrosis Factor Alpha decreased Serum Cholesterol Level, but not Albumin, in Hemodialysis Patients with Non-Fibrotic Hepatitis C Infection

Abstract

BACKGROUND: Hepatitis C infection could increase the morbidity and mortality of chronic kidney disease patients on hemodialysis by enhancing the inflammatory process. Tumor Necrosis Factor-alpha (TNF-a) is the main regulator of the inflammatory cascade, which could induce malnutrition and suppress cholesterol and albumin production in the liver. AIM: Therefore, this study aimed to determine the correlation between serum TNF-a level with serum albumin and cholesterol levels in chronic kidney disease patients on hemodialysis with and without hepatitis C infection. METHODS: This research was an analytical cross-sectional study. The sample of this study consisted of patients undergoing routine hemodialysis at Dr. Hasan Sadikin Hospital, Bandung, in February 2020. The sample selection was using a random sampling method and analyzed with the Spearman rank correlation test. RESULTS: One hundred nineteen patients were divided into two groups, with hepatitis C infection (n=53) and without hepatitis C infection (n=66). The median value of serum TNF-α _was higher in the hepatitis C infection group compared to the group without hepatitis c infection (31.86 pg/ml vs 11.71 pg/ml, p <0.001). There was a correlation between serum TNF-α _and cholesterol in the hepatitis C infection (r = -0.246; p = 0.039) and without hepatitis c infection group (r = -0.256; p = 0.022). After adjusting with the duration of hemodialysis, this association was found to be significant in patients without Hepatitis C infection (p = 0.02) and borderline significant in patients with Hepatitis C infection (p = 0.09). There was no correlation between TNF-α _with albumin in both hepatitis C infection group (r = 0.082; p = 0.281) and without hepatitis C infection (r = -0.168; p = 0.094). CONCLUSION: Serum TNF-α _negatively correlates with cholesterol levels in chronic kidney disease patients on hemodialysis with and without hepatitis C infection. However, there was no correlation between TNF-α _and albumin level in both groups.