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

  • Original Article—Liver, Pancreas, and Biliary Tract
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Abstract

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.

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Acknowledgments

This study was presented as an oral presentation (Hepatology International 3: 30, 2009) at the 19th conference of the Asian Pacific Association for the Study of the Liver; February 14–16, 2009; Hong Kong, China. The authors thank the following hospitals and physicians for participating in this study: Uemura Medical Clinic (Dr. Koichiro Komaru), Southern Region Hospital (Dr. Kanro Makisumi), Medical Corporation Gijyunkenshoukai Tanoue Hospital (Dr. Kanyo Tanoue), Terada Hospital (Dr. Kazunao Kuroshima), Yamashita Wataru Clinic (Dr. Wataru Yamashita), Kajiki Chuo Clinic (Dr. Toshihisa Mizuta), Kagoshima Seikyo Hospital (Dr. Hirokazu Kamimura), Koujyukai Yotsueda Naika (Dr. Kouji Yotsueda), Nansatsu Care Hospital (Dr. Shigehito Yoshimi), Oda Naika Clinic (Dr. Keiko Oda), Jingoan Clinic, Nanpuh Hospital, Saiseikai Sendai Hospital, Imamura Bun-in Hospital, Nishida Clinic, Kyomachi Kyoritsu Hospital and Ikeda Hospital.

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Authors and Affiliations

  1. Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Chika Nishida, Hirofumi Uto, Makoto Oketani, Koki Tokunaga, Tsuyoshi Nosaki, Mayumi Fukumoto, Manei Oku, Atsushi Sogabe, Akihiro Moriuchi, Akio Ido & Hirohito Tsubouchi

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  1. Chika Nishida
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  2. Hirofumi Uto
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  3. Makoto Oketani
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Correspondence to Hirofumi Uto.

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Nishida, C., Uto, H., Oketani, M. et al. Clinical significance of alanine aminotransferase levels and the effect of ursodeoxycholic acid in hemodialysis patients with chronic hepatitis C. J Gastroenterol 45, 326–334 (2010). https://doi.org/10.1007/s00535-009-0149-0

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