CRYOGLOBULINEMIA AMONG MAINTENANCE HEMODIALYSIS-PATIENTS AND ITS RELATION TO HEPATITIS-C INFECTION

It has been shown that hepatitis C virus (HCV) infection is closely as sociated with mixed type cryoglobulinaemia. It is also known that HCV infection is rampant among chronic haemodialysis patients. We studied 531 renal failure patients on maintenance dialysis including 170 with positive HCV antibodies for cryoglobulinaemia, and its incidence was c ompared with controls which consisted of 242 chronic hepatitis C patie nts without renal failure and 183 healthy adults. Cryoglobulinaemia wa s present in 30.6% of dialysis patients with HCV infection, 10.8% of d ialysis patients without HCV infection, 29.8% of patients with chronic hepatitis C without renal failure, and 0% of healthy adults. Among th e 30 new renal failure patients who were started on dialysis within 6 months, four were positive for HCV antibodies, and one of them had cry oglobulinaemia; of the 26 HCV-negative patients, four (15%) were cryog lobulinaemic. The cryocrit values among dialysis patients were much lo wer than those of the control cases and other reports on non-dialysis cases. Patients with cryoglobulinaemia were generally younger compared with patients negative for this condition. There was no correlation b etween cryoglobulinaemia and past blood transfusion, underlying diseas e or length of dialysis. Cryoglobulinaemic patients seem to develop re nal failure at relatively young ages and a considerable proportion of cryoglobulinaemic dialysis patients may have already had cryoglobulina emia at the time of the start of haemodialysis. There was no indicatio n that the presence of cryoglobulin in serum adversely affects the liv er disease nor increases serum virus load in HCV-infected dialysis pat ients. Thus, it was concluded that although HCV infection has a certai n role in the development of cryoglobulinaemia in dialysis patients, t hey develop cryoglobulinaemia less frequently and produce cryoglobulin to a lesser degree in the presence of HCV infection as compared with non-dialysis patients.