Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection

Clin Nephrol. 2004 May;61(5):347-51. doi: 10.5414/cnp61347.


Background: Chronic hepatitis C virus (HCV) infection is a common infectious agent in chronic hemodialysis (HD) patients. In this prospective case-control study, we aimed to investigate the influence of chronic HCV infection on erythropoietin (EPO) and iron requirement in HD patients.

Patients and methods: 49 HD patients (24 male, 25 female, mean age 47 +/- 15 years) were included. The mean time spent on dialysis was 39 +/- 38 months, and follow-up time was 1 year for this study. Biochemical analyses and complete blood counts together with iron status of the patients (transferrin saturation and serum ferritin levels) were measured monthly. Highly sensitive C-reactive protein (hs-CRP) levels were measured within 3-month intervals. Endogenous EPO levels were measured by enzyme-linked immunoassay 2 weeks after cessation of EPO treatment.

Results: Eleven of the HD patients (22%) were anti-HCV(+). There was no difference in age, sex, time on dialysis, distribution of primary renal diseases, predialytic BUN, Kt/V, albumin and i-PTH levels between HCV(+) and (-) patients. Anti-HCV-positive patients required significantly lower weekly doses of EPO (87 +/- 25 IU/kg vs 129 +/- 11 IU/kg, p = 0.042) and iron (16.8 +/- 12.2 mg vs 32.6 +/- 16.1 mg, p = 0.02) replacement than anti-HCV(-) group; hs-CRP levels were similar between study groups. Serum endogenous EPO levels were significantly higher in HCV(+) patients than HCV(-) HD patients (9.43 +/- 6.47 mU/ml vs 3.59 +/- 2.08 mU/ml, p = 0.008).

Conclusion: Anti-HCV(+) HD patients had higher serum EPO levels and required less EPO and iron replacement as compared to anti-HCV(-) patients. Because of the changes in iron metabolism, iron treatment should be carefully administered in HD patients with HCV.

MeSH terms

  • C-Reactive Protein / analysis
  • Case-Control Studies
  • Enzyme-Linked Immunosorbent Assay
  • Erythropoietin / administration & dosage*
  • Erythropoietin / blood
  • Erythropoietin / therapeutic use
  • Female
  • Follow-Up Studies
  • Hepatitis C Antibodies / analysis
  • Hepatitis C, Chronic / complications*
  • Humans
  • Iron / administration & dosage*
  • Iron / metabolism
  • Iron / therapeutic use
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Prospective Studies
  • Recombinant Proteins
  • Renal Dialysis*
  • Time Factors


  • Hepatitis C Antibodies
  • Recombinant Proteins
  • Erythropoietin
  • C-Reactive Protein
  • Iron