Viral Hepatitis
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 1, 2004; 10(15): 2209-2212
Published online Aug 1, 2004. doi: 10.3748/wjg.v10.i15.2209
Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up
Kunio Okuda, Osamu Yokosuka
Kunio Okuda, Osamu Yokosuka, Department Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Osamu Yokosuka, M.D., Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Telephone: +81-43-226-2083 Fax: +81-43-226-2088
Received: March 5, 2004
Revised: April 2, 2004
Accepted: April 9, 2004
Published online: August 1, 2004

AIM: Hepatitis C virus (HCV) infection is very common among end-stage kidney disease patients on hemodialysis, but its natural history is not known.

METHODS: In this study, 189 dialysis patients (case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparable periods. The longest follow-up was 23 years in dialysis cases. The disease activities were graded into “asymptomatic” if ALT was less than 40 (35 in cases) IU/L, “low activities” if ALT was 40 (35)-79 IU/L, and “high activities” if ALT was above 80 IU/L during the last or latest 4 year period.

RESULTS: All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA. Of the 50 controls followed up for more than 15 years, 34 had high activities, and none cleared HCV RNA. There were 60 controls who were asymptomatic, but they were all positive for HCV RNA, while 22.3% of asymptomatic dialysis cases were RNA negative. No dialysis patients with chronic hepatitis C progressed to cirrhosis, whereas the disease progressed to cirrhosis in more than one quarter of the controls. These differences were highly significant (P < 0.0001).

CONCLUSION: Chronic hepatitic C among hemodialysis patients is mild in disease activity, and is not progressive, perhaps due to immunological abnormalities in these patients. Hepatic C virus is frequently cleared in asymptomatic dialysis patients during a long course. A possible mechanism for viral clearance is viral particle destruction on the surface of the dialyzer membrane.

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