Hemodialysis patients infected with hepatitis C virus (HCV) have a significantly decreased requirement for erythropoietin (EPO) compared with hemodialysis patients with no history of HCV infection.
A team at Texas A & M University in Temple, led by Anand Khurana, MD, studied 66 hemodialysis patients: 22 with HCV infection and 44 age-, gender-, and race-matched controls without HCV. The mean EPO requirement for the HCV-infected group was 17,307 U/month compared with 49,134 U/month for controls, the investigators reported in Hemodialysis International (2008;12:94-99). The HCV-infected patients tended to have higher hemoglobin levels at baseline.
“The possible explanation for these findings may be the release of hepatic EPO because of chronic hepatic inflammation secondary to HCV,” the authors wrote.
The mean dose of IV iron was higher for the HCV group than controls (120 vs. 163 mg/month), but the difference was not statistically significant.
Hemodialysis patients who do not need EPO or have low requirements prompt investigation for acquired renal cystic disease, renal cell carcinoma, or polycythemia vera. “It should be a reason to look for occult HCV infection, given the higher risk of acquiring this infection on hemodialysis and having normal ALT levels,” the authors say.