Maintenance hemodialysis decreases serum hepatitis C virus (HCV) RNA levels in hemodialysis patients with chronic HCV infection

OBJECTIVE: Hepatitis C virus (HCV) infection is a major complication among hemodialysis patients the world over. To determine the natural course of HC V viremic levels in patients on maintenance hemodialysis, we prospectively quantified the HCV RNA levels in serial blood samples from hemodialysis pat ients and compared them with those in nonuremic subjects. METHODS: The population studied included 98 hemodialysis patients and 228 n onuremic subjects with chronic HCV infection. HCV RNA was detected by polym erase chain reaction (PCR) and the levels were determined by branched DNA p robe assay. HCV RNA genotypes were determined by PCR using type-specific pr imers. RESULTS: HCV RNA levels were significantly lower in hemodialysis patients ( median, 0.4 x 10(6) genome equivalent [Meq]/ml) than in nonuremic subjects (median, 3.0 Meq/ml) (p < 0.05). HCV of genotype Ib was prevalent in the he modialysis patients (81.6%) and nonuremic subjects (88.6%). HCV RNA levels in 20 hemodialysis patients with genotype Ib were significantly reduced aft er each hemodialysis procedure (p < 0.05). The 3-yr prospective observation from 1995 to 1998 showed a significant decrease of HCV RNA levels in 47 he modialysis patients with genotype Ib (median, 1.9-0.9 Meq/ml, pc 0.05), whe reas levels in 155 nonuremic subjects with genotype Ib did not decrease (me dian, 2.6-3.0 Meq/ml). There were no patients or nonuremic subjects with un detectable HCV RNA by a PCR assay during the observation period. CONCLUSIONS: These observations suggest that maintenance hemodialysis decre ases the HCV RNA levels in hemodialysis patients with chronic HCV infection , but does not produce clearance of the viremia. (C) 2000 by Am. Cell. of G astroenterology.