Investigation of possible clinical and laboratory predictors of liver fibrosis in hemodialysis patients infected with hepatitis C virus.

ABSTRACT

Hepatitis C virus (HCV) infection is common in patients with end-stage renal disease. The severity of liver damage, including fibrosis, in these cases varies widely. Although many investigators have searched for noninvasive alternatives to liver biopsy for evaluating the extent of liver fibrosis, no useful noninvasive predictors have been found. Currently, liver biopsy is essential to assess the degree of fibrosis. The aim of this retrospective study was to investigate a range of clinical and laboratory parameters in HCV-infected hemodialysis (HD) patients and identify possible predictors of fibrosis. Ninety-five consecutive HD patients with HCV infection underwent liver biopsy. Each specimen was evaluated for fibrosis stage. Correlations were sought between the degree of fibrosis and the age, HD duration, time since first possible HCV exposure, body mass index, HCV RNA titer, serum ferritin level, and serum alanine aminotransferase (ALT) level. The analysis revealed no significant correlations between fibrosis stage and the parameters investigated (mean age r =.017, P =.89; mean HD duration r =.066, P =.576; body mass index r =.231, P =.152; HCV RNA titer r =.015, P =.091; serum ferritin r =.134, P =.32; serum ALT r =.108, P =.927). Links with serum ALT were reevaluated with upper normal levels arbitrarily set at 30 IU/L and 20 IU/L, but these analyses also revealed no correlations between fibrosis stage and ALT level (P =.98 and P =.449, respectively). Therefore liver biopsy is still essential for accurate assessment of liver pathology in HD patients with HCV.