Effect of HBV versus HCV Infection on the Response to Erythropoietin Therapy in the Treatment of Anaemia in Prevalent Haemodialysis Patients

Abstract

Patients with ESRD on dialytic support are usually anemic due to lack of EPO secretion from the kidney. The long-term survival and good quality of life of patients with chronic renal failure depend, among other factors, on hemoglobin, iron status, and bone marrow response to erythropoiesis stimulating agents. A few exceptions include polycystic kidney disease where kidneys are able to maintain EPO secretion despite loss of other functions. Patients with HCV infection were associated with higher hemoglobin and hematocrit compared with non-infected patients. A highly significant association of hemoglobin and hematocrit with HCV infection and the relation between HCV infection and erythropoiesis has been proposed to be either due to the secretion of erythropoietin from regenerating liver cells or due to alternations in iron metabolism. This study was conducted to assess the relation between anemia and HCV and HBV infection and anemia in hemodialysis population and to identify the possible relation to erythropoietin doses. This study included 60 HD patients selected from dialysis unit in Damanhur fever hospital; divided into 3 groups according to their virology state into HCV positive, HBV positive group and negative group. In the present study, hemodialysis patients with HCV and hemodialysis patients with HBV infection had higher mean hemoglobin, than negative group but with no significant statistical difference. There was significant statistical difference in MCV, MCH and WBC distribution among the three groups. However there was no significant statistical difference in the majority of CBC profile as HCT, RBC, MCH.C, RDW-CV, RDW-SD and PLT distribution among the three groups. There was significant statistical difference in total Erythropoietin dose among the three groups it was lowest in HCV group then in HBV and was higher in control group. There was no significant statistical difference in TIBC, Transferrin, Transferrin Saturation, PTH, Serum Iron and Serum Ferritin among the three groups, while there was a significant statistical difference in Serum Ferritin as it was higher in negative group. There was a significant statistical difference in SGPT and SGOT among the three groups with higher levels were in negative group. There was a significant statistical difference in CRP, blood urea and Serum creatinine distribution among the three groups. There was no significant statistical difference in HB at 0 month, HB at 2 months and HB at 4 months of follow up among the three groups, while there was a significant statistical difference in HB at 6 months among the three groups. There is a negative, weak and non-significant relationship between the total erythropoietin dose and