Chronic liver damage in hemodialysis users. The importance of molecular tests for detection of hidden infection by hepatotropic viruses in high-risk groups

Introduction and Objectives

Worldwide, cirrhosis secondary to the hepatitis C virus is the first indication for liver transplantation. In Mexico, alcohol abuse, viral hepatitis, and obesity are the highlighted causes. Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Hemodialysis users are a high-risk group with high prevalence of HCV. The aim of this study was to identify patients with liver damage in hemodialysis users and their relationship with viral hepatitis, diagnosis, and management.

Materials and Patients

We reviewed the electronic medical records of hemodialysis users from January 1, 2017, to December 31, 2019. All patients who underwent at least one hemodialysis procedure were included. We used descriptive statistics with the SPSS v21 program.

Results

We analyzed 362 patients, 57% of whom were men, with a mean age of 52. The most frequent etiology attributable to kidney damage was hypertension 96% and diabetes mellitus 59%. The mean time on hemodialysis was 19 months. The biochemical and serological characteristics of the group are show in Table 1. We found forty-seven patients with transaminasemia, of which thirteen had liver cirrhosis, evaluated by FIB4/APRI. A viral load was requested for hepatitis C in only one patient, with a positive result, who received treatment with glecaprevir/pibrentasvir for 12 weeks without complications. Retrospective review limits us in identifying the cause for which the patients did not undergo molecular tests for hepatitis B and C. These patients have significant depression of immunity with negative serology on the presence of viral replication “hidden infection.”

Conclusions

Hemodialysis users should be exhaustively studied, and molecular tests should be performed on suspicion of viral hepatitis.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1.

Biochemical and serological characteristics of hemodialysis users

Variable	Without transaminasemia n=315	With transaminasemia n=47
Hemoglobin g/dL	9	9
Platelet K/µL	228	217
AST	23	74
ALT	25	70
Antibodies HBV, HCV (n)
2017 y (32)	27	5
2018 y (101)	89	12
2019 y (229)	200	29

Footer: y (year)