HCV Changes Dialysis Treatment Needs

ASN: HCV Changes Dialysis Treatment Needs
By Todd Neale, Staff Writer, MedPage Today
Published: October 30, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
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* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

SAN DIEGO -- Patients on dialysis need less epoetin to treat their anemia if they are infected with hepatitis C (HCV), a researcher reported here.

HCV-positive patients also needed a lower dose of IV iron than their noninfected counterparts, even though they had similar hemoglobin levels, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.

This is a "surprising, unusual finding," Goodkin said at the American Society of Nephrology meeting, because most inflammatory diseases, which interfere with the signal the bone marrow sends to make more red blood cells, would result in the need for a higher dose of epoetin.

"We speculate that it may be that this viral infection is actually stimulating the liver to make this hormone erythropoietin," Goodkin said, although he admitted that he doesn't know why the virus would activate the erythropoietin-producing cells.

He said the finding would probably not affect clinical practice because patients on dialysis have their epoetin doses adjusted regularly anyway.

"The doctors are still going to follow the hemoglobin level and adjust the EPO dose," Goodkin said. "This is just a clue that if it's hepatitis C-positive, they'll need less EPO, on average, than people who are hepatitis C-negative."

Goodkin said he decided to investigate after he saw the results of a small case-control study from 2008, involving 66 patients, showing that those on dialysis who were infected with HCV needed significantly lower doses of erythropoietin (P<0.01). There was also a trend toward lower IV iron requirements (P<0.07).

To explore the issue on a larger scale, he turned to the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS).

The current analysis included 36,245 patients in 12 countries who were on hemodialysis, 7.8% of whom were positive for HCV.

After adjusting for age, sex, race, years of hemodialysis, country, and 14 comorbidities, he and his colleagues found that the weekly epoetin dose was significantly lower in the HCV-positive patients (7,737 versus 8,210 Units, P=0.02).

IV iron dose was also significantly lower in the infected patients (89.2 versus 96.4 mg/month, P=0.02).

Hemoglobin concentration was not significantly different in the two groups (P=0.46).

The odds ratios for not receiving epoetin or IV iron therapy among HCV-positive patients were 1.15 (P=0.002) and 1.19 (P=0.0002), respectively.

Hepatitis B infection, on the other hand, offered no advantage.

In addition to the unexpected effect of HCV infection on the epoetin dose, another surprising finding was that only seven infected patients in the study received antiviral treatment, including interferon.

Goodkin speculated that clinicians might have been sparing the patients the adverse effects of antiviral therapy because most HCV-positive patients do not develop cirrhosis and liver failure, and patients on dialysis, many of whom are older, have a limited lifespan.

DOPPS is funded by Amgen, Kyowa Hakko Kirin, and Genzyme.

Goodkin reported relationships with Affymax, AMAG Pharmaceuticals, Amgen, FibroGen, Keryx, Seattle Life Sciences, Xenon Pharmaceuticals, and Urodynamix Technologies.

Primary source: American Society of Nephrology
Source reference:
Goodkin D, et al "Epoetin and IV iron dose requirements are reduced by hepatitis C infection in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study" ASN 2009; Abstract TH-PO276.