Chronic hepatitis C infection is associated with higher hemoglobin levels in hemodialysis patients, but hepatitis B infection is not

BACKGROUND: Chronic hepatitis is associated with increased hemoglobin level in patients with end-stage renal disease. The aim of this study was to define the individual and combined influence of chronic hepatitis B and C infections on red blood cell status. METHODS: A total of 524 chronic hemodialysis patients at 5 hemodialysis centers were retrospectively reviewed for the period from March 1 to June 31, 2005. The results of testing using a third-generation enzyme-linked immunosorbent assay showed that 345 patients (65.8%) had neither HBV nor HCV (NBC), 55 patients (10.5%) had HBV, 108 (20.6%) had HCV, and 16 (3.1%) had concurrent HBV and HCV infection (BBC). Differences between the 4 groups of patients in the parameters studied were investigated using a multivariate general linear model with the Sidak post hoc test. RESULTS: The hemoglobin and hematocrit of patients with HCV were 10.5 ± 1.6 g/dL and 31.6% ± 4.7%, respectively, which were significantly higher than the 9.9 ± 1.4 g/dL and 29.7% ± 4% of NBC patients (p = 0.002 and p = 0.001). The erythropoietin (EPO) dose given to patients with HCV was 39.3 ± 40.3 IU/kg/week, significantly lower than the 58.1 ± 40.6 IU/kg/week for those with NBC. The results of the multivariate linear regression analysis suggested that erythropoietin dose, elevated liver functional test results, and HCV infection were major factors affecting red cell production (p < 0.001, p < 0.02, and p < 0.05, respectively). CONCLUSION: Hepatitis C virus infection was associated with an increased number of red blood cells, which led to a lowering of the necessary EPO dose, whereas hepatitis B virus infection was not.