الفهرس 
Hepatitis (C) Virus and chronic Kidney DiseaseOnly 14 pages are availabe for public view
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Abstract
Patients undergoing maintenance hemodialysis (MHD) have a significantly higher annual incidence of hepatitis C virus (HCV) infection, depending on the country.
Short term morbidity and mortality are significantly higher in HCV infected dialysis patients, and these patients frequently die before the development of long term HCV complications.
Hemodialysis patients experience exaggerated risks of mortality and cardiovascular morbidity that are not fully explained by the highly prevalent, more traditional cardiovascular risk factors.
Numerous observational analyses suggest that disorders of bone and mineral metabolism, collectively known as CKD–mineral and bone disorder (CKD-MBD), are involved in the pathogenesis of this higher risk.
These analyses typically estimate the risks associated with parathyroid hormone (PTH), calcium, and phosphate and sometimes use these results to establish the relative importance of each as a therapeutic target.
Due to the high prevalence of hepatitis C infection in our country, and the importance of the Chronic Kidney Disease – Mineral and bone disease, our study aimed to find a possible correlation between the two factors.
Our study is a descriptive (cohort) study consisted of 90 patients with chronic kidney disease (stage 5D) undergoing regular hemodialysis in Ain Shams University hospital.
These patients were further classified in to 3 groups:
1. 30 patients with HCV Antibody negative serology
2. 30 patients with HCV Antibody positive serology with stigmata of chronic liver disease
3. 30 patients with HCV Antibody positive serology without stigmata of chronic liver disease.
Before enrollment, the study was fully explained to all participating patients, especially focusing on the study purpose and the precise procedures to be used.
Exclusion criteria:
1. Patients with hemodialysis duration less than 6 months
2. Patients with parathyroidectomy.
3. Patients with known metabolic bone disease before starting hemodialysis, not related to chronic kidney disease were excluded from our study.
4. Patients with other causes of CLD rather than hepatitis c virus.
Although bone histology remains the “gold standard” for definitive diagnosis of the osteodystrophic lesion, in routine clinical practice nephrologists relies on noninvasive methods for assessment of bone turnover, such as intact parathyroid hormone (iPTH) levels and bone specific alkaline phosphatase, as well as other non invasive blood tests.
Bone biopsy was performed on patients who were indicated clinically according to the KDOQI guidelines, or when the diagnosis of bone disease was doubtful with the non invasive biochemical markers.
Bone biopsies were taken for 21 patients, 9 patients with HCV Antibody negative serology, 7 patients with HCV Antibody positive serology and stigmata of chronic liver disease, and 5 patients with HCV Antibody positive serology without stigmata of chronic liver disease. A Bard® Ostycut® disposable needle (14gms x 12.5 cm) was used, after double tetracycline labeling. Samples taken were examined by light microscopy and ultraviolet light.
Our results showed that the dominant pattern of bone disease in all studied groups was the hyperparathyroid bone disease (50%), closely followed by the ABD or [the low turnover uremic osteodystrophy] (40%).
Regarding the selected three groups mentioned before, the group of HCV Ab negative serology (n=19), and the group of HCV Ab positive serology with no stigmata of chronic liver disease (n=24), both showed an increased prevalence to hyperparathyroid bone disease (60% and 56.7%) respectively.
However, the group of HCVab positive serology with stigmata of chronic liver disease (n=26), showed a higher prevalence to low turnover uremic osteodystrophy or adynamic bone disease (ABD).
Our study showed significant correlations in the HCVab negative group and HCV Ab positive with no stigmata of chronic liver disease group of patients in terms of:
a) Positive correlation between bone alkaline phosphatase and intact PTH.
b) positive correlation between bone alkaline phosphatase and B2 microglobulins.
c) Inverse correlation between bone alkaline phosphatase and serum corrected calcium.
However, there were no significant correlations in the HCVab positive patients with stigmata of chronic liver disease group.
Possibly, these findings demonstrates that hepatitis C infection alone without manifestations of chronic liver disease, may not have a specific influence or impact on the pattern of bone disease in hemodialysis patients, however, further studies including hepatitis C PCR, would be needed to confirm this suggestion.
On the other hand, patients with manifested chronic liver disease, showed a different pattern of bone disease. Putting in consideration the possible effect of (hepatic osteodystrophy) that was not addressed in our study, further studies should be conducted to verify our finding.