Clinical significance of alanine aminotransferase levels and the effect of ursodeoxycholic acid in hemodialysis patients with chronic hepatitis C

• Published in: Journal of gastroenterology Vol. 45; no. 3; pp. 326 - 334
• Main Authors: Nishida, Chika, Uto, Hirofumi, Oketani, Makoto, Tokunaga, Koki, Nosaki, Tsuyoshi, Fukumoto, Mayumi, Oku, Manei, Sogabe, Atsushi, Moriuchi, Akihiro, Ido, Akio, Tsubouchi, Hirohito
• Format: Journal Article
• Language: English
• Published: Japan Japan : Springer Japan 01-03-2010; Springer Japan; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Alanine Transaminase - drug effects; Alanine Transaminase - metabolism; Antibodies; Aspartate; Biliary Tract; Cholagogues and Choleretics - pharmacology; Colorectal Surgery; Female; Follow-Up Studies; Gastroenterology; Health aspects; Hemodialysis; Hepatitis C Antibodies - blood; Hepatitis C virus; Hepatitis C, Chronic - complications; Hepatology; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article—Liver; Pancreas; Platelet Count; Renal Dialysis; Retrospective Studies; RNA; Surgical Oncology; Thrombocytopenia - epidemiology; Thrombocytopenia - virology; Time Factors; Ursodeoxycholic Acid - pharmacology; Ursodiol; Viral antibodies; Thrombocytopenia; ALT; HCV; Hemodialysis; Ursodeoxycholic acid
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-009-0149-0

Background The natural history of hepatitis C virus (HCV) carriers and the effect of ursodeoxycholic acid (UDCA) have not been fully elucidated among hemodialysis (HD) patients. Methods Eighty-four anti-HCV antibody- and HCV RNA-positive and 154 anti-HCV antibody-negative HD patients who were retrospectively observed for at least 3 years were analyzed. We investigated the factors associated with thrombocytopenia (< 1.3 × 10⁵/μL) and decreased platelet count (PLT) (more than 20% decrease during the follow-up period), which were considered to be indicators of hepatic fibrosis. In addition, another 16 HD patients with HCV who received 300 mg/day UDCA orally for at least 6 months were investigated. Changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT) and PLT were assessed. Results After the 60.3-months mean follow-up period, HCV infection was independently associated with both thrombocytopenia [odds ratio (OR) 2.589] and decreased PLT (OR 2.339) in 238 HD patients. In 84 HD patients with HCV, the average ALT levels (≥ 15 IU/L) during the follow-up period was associated with thrombocytopenia (OR 3.882) and decreased PLT (OR 4.470). In addition, ALT, AST and GGT significantly decreased at 6 months after starting UDCA, but PLT did not change in 16 HD patients with HCV. Conclusions These results indicate that HCV infection is a risk for thrombocytopenia which should be associated with hepatic fibrosis in HD patients. In addition, the clinical course of ALT levels predicts the progression of thrombocytopenia, and UDCA may effectively lower ALT levels in HD patients with HCV.