NEW YORK (Reuters Health) Sept 21 - The presentation and natural history of chronic hepatitis C differs between patients with and without end-stage renal disease (ESRD), according to a report in the September American Journal of Gastroenterology.

Though the natural history of chronic hepatitis C in patients with normal renal function has been studied extensively, the authors explain, this is the first report of its natural history in patients with ESRD.

Dr. Ke-Qin Hu from University of California, Irvine Medical Center, Orange, and colleagues investigated the clinical presentation of chronic hepatitis C and factors associated with stage III-IV fibrosis in 91 patients with chronic hepatitis C and ESRD on hemodialysis, compared with 159 otherwise similar patients without renal failure.

Patients with ESRD had a lower mean body-mass index and a lower frequency of fibrosis than did patients without renal failure, the authors report. Patients with ESRD were more likely to have diabetes than were patients without renal failure.

ESRD patients were less likely than the others to present with elevated liver enzymes (ALT and AST), the results indicate, and more likely to present with hypoalbuminemia.

"The frequency of elevated alpha-fetoprotein (AFP) is significantly lower in patients with chronic hepatitis C and ESRD than in those with chronic hepatitis C and normal renal function," the investigators report.

Hepatic steatosis and thrombocytopenia were independently associated with stage III-IV fibrosis in ESRD patients, the researchers note, even after accounting for a history of diabetes, elevated AST level, and splenomegaly.

"Except for a history of diabetes mellitus and a lower frequency of elevated AST, the overall presentation of stage III-IV fibrosis is similar in chronic hepatitis C patients with ESRD or normal renal function," the authors conclude.

"Additional study with a larger cohort of patients will be needed to determine whether a low level of AFP is associated with less activity and progression of hepatitis C virus disease in patients with ESRD," the researchers add.

Am J Gastroenterol 2005;100:2010-2018.

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