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Vol. 27, No. 2, 2007
Issue release date: April 2007
Am J Nephrol 2007;27:191–196

Hepatitis C in Chronic Kidney Disease: Predialysis Patients Present More Severe Histological Liver Injury than Hemodialysis Patients?

Lemos L.B. · Perez R.M. · Lemos M.M. · Lanzoni V.P. · Draibe S.A. · Silva I.S. · Silva A.E.B. · Ferraz M.L.G.
Divisions of aGastroenterology and bNephrology, and cDepartment of Pathology, Federal University of São Paulo, São Paulo, and dDepartment of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

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Background: The characteristics of hepatitis C virus (HCV) infection in predialysis patients are poorly understood and they could be different from hemodialysis patients. Aims: To evaluate the demographics, laboratory and histological characteristics of chronic HCV infection in predialysis patients and to compare them with those observed in hemodialysis patients. Methods: Thirty-nine predialysis patients with chronic HCV infection were compared to HCV-infected hemodialysis patients (ratio of 1:3) in terms of demographics, laboratory and histological characteristics. The fibrosis progression rate (FPR) was calculated as the ratio between fibrosis stage and duration of infection. Results: Predialysis patients were older (57 ± 10 vs. 45 ± 12 years; p < 0.001), presented a higher proportion of elevated alanine aminotransferase (71.8 vs. 41.0%; p = 0.001) and aspartate aminotransferase (64.1 vs. 26.5%; p < 0.001), a higher proportion of interface hepatitis (66.7 vs. 47%; p = 0.033) and more advanced fibrosis (71.8 vs. 16.2%; p = 0.001). Among patients with estimated duration of infection, predialysis patients presented a longer duration of infection (22 vs. 6 years; p < 0.001) and no difference in FPR was observed between groups (p = 0.692). Conclusion: Although predialysis patients with HCV infection present more severe histological injury than hemodialysis patients, this finding probably reflects a longer duration of infection with no evidence supporting that hepatitis C presents a more aggressive course in this group.

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