The Turkish Journal of Gastroenterology

The Turkish Journal of Gastroenterology
2009, Volume 20, No 4, Page(s) 243-246
[ Summary ] [ PDF ] [ Similar Articles ] [ Mail to Author ] [ Mail to Editor ]
The quality of life in hemodialysis patients with chronic hepatitis C virus infection
Filiz AKYÜZ¹, Fatih BEŞIŞIK¹, Binnur PINARBAŞI¹, Kadir DEMİR¹, Sabahattin KAYMAKOĞLU¹, Yılmaz ÇAKALOĞLU¹, Mehmet Şükrü SEVER², Atilla ÖKTEN¹
Departments of ¹Gastroenterohepatology and ²Nephrology, İstanbul University, School of Medicine, İstanbul
Keywords: Hemodialysis, health quality, hepatitis C virus.
Summary
Background/aims: We aimed to determine the quality of life in treated and untreated hemodialysis patients with chronic hepatitis C virus infection. Methods: Ninety-five chronic renal failure patients with positive antiHCV/HCV-RNA were enrolled in this prospective study. All patients were questioned using the Short Form-36 (SF-36) health survey to evaluate life quality after the treatment. Fifty-five (ALT>1.5 ULN) were treated with interferon-alpha-2b [3MU/tiw, sc, 6 (30 patients) and 12 (25 patients) months], and 40 (11 renal transplanted) were untreated. Fifteen patients had renal transplantation in a mean of 24.6±12.5 months after interferon-alpha treatment. Results: The mean age of the patients was 37±10 years, and 58 were male. The mean durations of hemodialysis and renal transplantation were 6.4±3.8 and 5.9±4.6 years, respectively. Interferon treatment had a negative effect on general health perception, physical activity and anxiety about the disease (p<0.05) when compared with the untreated patients. General health perception scores were positively slightly increased in interferon responder patients (p>0.05). General health and physical activity were better in transplanted patients than patients undergoing hemodialysis (p<0.05). Conclusions: General health perception slightly increased positively in interferon responder patients. However, general health perception and physical activity were affected negatively by interferon treatment in the whole group analysis. Renal-transplanted patients have a better life quality compared with those on hemodialysis.	Top Summary Introduction Materials And Methods Results Discussion References
Introduction
Quality of life is one of the important indicators of the effects of medical treatment. Hemodialysis patients experience various problems that may adversely influence their quality of life (1). Hepatitis C virus (HCV) infection is also an important problem in hemodialysis patients, especially after renal transplantation while receiving the immunosuppressive therapy (2). This is the most important comorbid disease that can affect their quality of life. Therefore, these patients must be treated if they are candidates for renal transplantation. Life quality is unknown in treated and untreated patients with chronic HCV infection undergoing hemodialysis. We aimed to determine the life quality in treated and untreated chronic renal failure patients with chronic HCV infection.	Top Summary Introduction Materials And Methods Results Discussion References
Materials And Methods
Ninety-five antibody to HCV (antiHCV)- and HCV-RNA-positive chronic renal failure patients were enrolled consecutively in this prospective study. All patients were questioned using the Short Form-36 (SF-36) health survey to evaluate their life quality after the treatment. The SF-36 includes 36 multiple-choice questions, arranged in different categories, four each in the areas of mental health (Role Limitation-Emotional, Vitality, Mental Health and Social Functioning) and of physical health (Physical Functioning, Role Limitation- Physical, Bodily Pain, General Health). Fifty-five [alanine aminotransferase (ALT) >1.5 times upper limit of normal] patients were treated with interferon (IFN)-alpha-2b (3 MU/tiw, sc) for a median 48 months before administration of the questionnaire (30 received IFN for 6 months; 25 for 12 months). Normal ALT and negative HCVRNA [by polymerase chain reaction (PCR)] were accepted as therapy response. Fifteen patients had renal transplantation in a mean of 24.6±12.5 months after completing IFN-alpha treatment. Forty (11 renal transplanted) patients were untreated. Individual values were compared with the values of the 40 untreated patients. All of the other known etiologies of chronic hepatitis were negative in these patients. Cirrhosis was excluded clinically. Liver biopsy was not performed because of the bleeding risk in this group of patients. AntiHCV was determined by UBI EIA 4.0 (Organon Teknika, Holland). HCV-RNA was determined by PCR (Roche Cobas Amplicor, Germany). Informed consent was obtained from each patient included in the study, and the protocol was approved by the local ethics committee. Data are presented as mean±SEM. Data analysis was made by the nonparametric tests and correlation tests SPSS 11.0 version for Windows, where appropriate. A value of p<0.05 was considered statistically significant.	Top Summary Introduction Materials And Methods Results Discussion References
Results
The mean age of the patients was 37±10 years, and 58 were male. Mean durations of hemodialysis and renal transplantation were 6.4±3.8 and 5.9±4.6 years, respectively. Treated and untreated patients’ features are shown in Table 1. IFN treatment response rate was 30% and 45%, respectively, in patients who received therapy for 6 and 12 months (p=0.05). Statistical analyses were done both in treated-untreated (Table 2) and dialysis-transplanted patients with respect to SF-36 scores. There was a negative correlation between IFN treatment and health perception (p=0.014, r=-0.23) (Figure 1). Mild and severe physical activity were also limited in IFN-treated patients (p=0.0028, p=0.001). General health perception scores positively increased in IFN responder patients, but the difference was not statistically significant compared to nonresponders (p>0.05). General health and physical activity were better in transplanted patients than hemodialysis patients (p=0.001). A positive correlation was observed between health perception and renal transplantation (p=0.004, r=0.27) (Figure 2). Enjoyment of life was worse in hemodialysis patients compared to those who were transplanted (p=0.018). Vitality was statistically higher in transplanted patients (p=0.017).	Top Summary Introduction Materials And Methods Results Discussion References
Discussion
In recent years, many physicians feel compelled to evaluate the life quality of patients with chronic diseases. This may help to define a treatment algorithm in these patients. Unfortunately, we have not succeeded in obtaining 100% response with any therapy in most of the chronic diseases. HCV is an important cause of morbidity and mortality in chronic dialysis patients. In Turkey, HCV is the most common infection (14-82%) in hemodialysis patients (3). Therefore, these patients must be treated if they are candidates for renal transplantation. However, IFN has many adverse effects and long-term virologic response is approximately 37% (4). Therefore, we need to determine life quality in IFN-treated and untreated hemodialysis patients. We performed our study after IFN treatment to evaluate real life quality, because it is known that IFN has several adverse effects that can affect life quality during the treatment. This study showed that health perception is good in transplanted patients and that IFN treatment negatively affects life quality. While there are some studies about life quality in chronic renal failure patients and chronic hepatitis C patients, there is no reported data about the life quality in treated and untreated dialysis patients with chronic hepatitis C. Interestingly, our data showed that general health and physical activity were poor and anxiety about the disease was higher in the IFNtreated patients (p<0.05) as compared with untreated patients. Bianchi et al. (5) evaluated life quality in a series of 126 outpatients with chronic hepatitis C (37 on and 89 not on active IFN treatment). They reported that active IFN treatment causes considerable distress in chronic hepatitis C patients, adding to the perceived change in health status caused by liver disease (5). Ware et al. (6) showed that successful treatment of chronic hepatitis C improved health-related quality of life as measured by both chronic hepatitis C-specific and generic measures of functional health and well-being. Our data revealed that general health perception scores had a slight positive corelation with IFN treatment response; however, the difference was not statistically significant when compared with the untreated patients. Our patients were not on active therapy. They received IFN therapy a median of 48 months ago. Nevertheless, our data showed that IFN treatment negatively affected life quality. None of the patients had an active clinical problem when they were questioned. Renal transplantation positively affects life quality. Ogutmen et al. (7) also showed that transplant renal replacement therapy provided a better quality of life compared with other replacement methods (hemodialysis and peritoneal dialysis). In conclusion, the response rate to IFN treatment is acceptable in hemodialysis patients. However, IFN negatively affects general health and physical activity when compared with untreated patients with chronic renal failure. Transplantation is the best treatment for improving life quality.	Top Summary Introduction Materials And Methods Results Discussion References
References
1. Morsch CM, Goncalves LF, Barros E. Health-related quality of life among haemodialysis patients -- relationship with clinical indicators, morbidity and mortality. J Clin Nurs 2006; 15: 498-504. 2. Gonzalez-Roncero F, Gentil MA, Valdivia MA, et al. Outcome of kidney transplant in chronic hepatitis C virus patients: effect of pretransplantation interferon-alpha2b monotherapy. Transplant Proc 2003; 35: 1745-7. 3. Besisık F, Okten A, Sever M. Renal transplantasyon yapılmış hastalarda anti-HCV seropozitifliğinin klinik önemi. Klimik 1994; 6: 31-4. 4. Fabrizi F, Dulai G, Dixit V, et al. Meta-analysis: interferon for the treatment of chronic hepatitis C in dialysis patients. Aliment Pharmacol Ther 2003; 18: 1071-81. 5. Bianchi G, Loguercio C, Sgarbi D, et al. Reduced quality of life in patients with chronic hepatitis C: effects of interferon treatment. Dig Liver Dis 2000; 32: 398-405. 6. Ware JE Jr, Bayliss MS, Mannocchia M, Davis GL. Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology 1999; 30: 550-5. 7. Ogutmen B, Yildirim A, Sever MS, et al. Health-related quality of life after kidney transplantation in comparison intermittent hemodialysis, peritoneal dialysis, and normal controls. Transplant Proc 2006; 38: 419-21.	Top Summary Introduction Materials And Methods Results Discussion References
[ Summary ] [ PDF ] [ Similar Articles ] [ Mail to Author ] [ Mail to Editor ]