Skip to main content
Egyptian Liver Journal
Download PDF

Malnutrition inflammation index in chronic haemodialysis patients with or without hepatitis C virus infection

Egyptian Liver Journal volume 10, Article number: 20 (2020) Cite this article

Abstract

Background

Hepatitis C virus infection is one of the main causes of chronic liver disease worldwide. Both chronic hepatitis C and chronic kidney disease are common and serious diseases; this work aimed to determine the clinical impact of HCV infection on malnutrition inflammation index score in chronic kidney disease patients.

This study was conducted on 96 patients on haemodialysis. They were divided into two groups. The first group was composed of 46 patients who were on maintenance haemodialysis and had chronic hepatitis C. The second group was composed of 50 patients on haemodialysis who were negative for hepatitis C.

Results

HCV-infected patients were associated with higher malnutrition inflammation score values (10% had MIS 16–20) compared to non-infected patients (2% only had MIS 16–20).

Conclusion

The prevalence of malnutrition was higher in the HCV-positive than the HCV-negative group.

Background

HCV infection is one of the main causes of chronic liver disease worldwide [1]. The number of infected persons may be about 160 million, but most are unaware of their infection [2]. The long-term impact of HCV infection is highly variable from minimal changes to extensive fibrosis and cirrhosis with or without hepatocellular carcinoma [1]. Both HCV and chronic renal disease are common and potentially serious diseases [3]. Patients undergoing maintenance haemodialysis have a significantly higher prevalence of HCV infection and malnutrition inflammation complex syndrome (MICS) [4]. Malnutrition causes cardiovascular mortality in dialysis patients [5] and decreases the quality of life of haemodialysis patients [6].

This work aimed to determine the clinical impact of HCV infection on malnutrition inflammation index score in chronic kidney disease patients.

Methods

Design of the study

Our patients in this study were selected from those who attended Sherbeen Central Hospital (Dakahlia), Haemodialysis Unit.

Sample size and selection of the patients

This study was conducted on 96 patients (61 males and 35 females) on haemodialysis from April 2016 to December 2016, and they were divided into two groups: the first is 46 haemodialysis patients with positive HCV infection; the second is 50 haemodialysis patients with negative HCV infection. Patient ages range between 20 and 60 years.

Inclusion criteria

The inclusion criteria are as follows: chronic kidney disease patients on haemodialysis and patients aged from 20 to 60 years.

Exclusion criteria

The exclusion criteria are as follows: patients who had clinical or laboratory evidence of active infectious disease 1 month before the study onset and patients with history of tumours.

Methods of the study

They were evaluated by Malnutrition-Inflammation Score, and clinical examination with special stress on some items (Fig. 1).

Fig. 1
figure 1

MIS. *Major comorbid conditions included congestive heart failure class III or IV, full-blown AIDS, severe coronary artery disease, moderate to severe chronic obstructive pulmonary disease, major neurologic sequelae, and metastatic malignancies or recent chemotherapy Suggested equivalent increments for serum transferrin are > 200 (0), 170 to 200 (1), 140 to 170 (2), and <140 mg/dL [7]

Full size image

Laboratory investigations

These are as follows: serum calcium, potassium, and sodium; complete blood count (CBC); blood urea; serum creatinine; C-reactive protein (CRP); ELISA for HCV antibody; PCR for hepatitis C-positive ELISA patients; total iron-binding capacity (TIBC); and serum transferrin.

Statistical analysis

All statistical analyses were performed by using the Statistical Package for the Social Sciences (SPSS) software version 15.0 (SPSS Inc., Chicago, IL) and GraphPad Prism package v.5.0 (GraphPad Software, San Diego, CA). Continuous variables were expressed as mean ± standard deviation (SD). ANOVA or Student’s t test for continuous variables and chi-square (χ2) for categorical variables were used to determine differences between groups. A P value of < 0.05 was considered statistically significant. The correlation coefficients (r) were assessed by Pearson’s correlation coefficient or Spearman’s correlation coefficient as appropriate.

Results (Table 1)

Independent sample t test showed that there was no significant difference (P > 0.05) between the two groups of subjects in the count of red blood cells, white blood cells, and platelets. In addition, there was no significant difference (P > 0.05) in haemoglobin levels between the two groups (Tables 1 and 2).

Table 1 Baseline data for included HCV-non-infected and HCV-infected haemodialysis patients
Full size table
Table 2 Comparison of haematology parameters between HCV-non-infected and HCV-infected haemodialysis patients
Full size table
Table 3 Comparison of renal function parameter between HCV-non-infected and HCV-infected haemodialysis patients
Full size table
Table 4 Association of iron metabolism markers and other biochemical parameters with HCV infection
Full size table

Independent sample t test revealed that there were no significant differences (P > 0.05) between the two groups as regards serum iron markers (TIBC and serum transferrin) and CRP levels, while there were highly significant differences between two the groups in the albumin level (P = 0.0001) (Tables 3 and 4).

Table 5 The frequency distribution of the Malnutrition-Inflammation Score in HCV-infected group compared to non-infected group
Full size table

In the present study, we found that total MIS score was significantly higher in the HCV-infected group than the non-HCV group (Table 5).

Discussion

In the current study, the male to female ratio was 32/14 in infected HCV on haemodialysis that reflected increased incidence of HCV infection among males.

Our findings agreed with those recorded in Sudan among haemodialysis patients [8]. In both groups, there was decreased haemoglobin level which was below normal as it was 8.8 ± 0.2 g/dL in the non-HCV infection group and 8.4 ± 0.2 g/dL in the HCV infection group. That was in accordance with the findings of Boubaker et al. [9].

Platelet count was less in the HCV group than in the negative HCV group although this difference was still non-significant [10].

We found that serum albumin was significantly decreased in the HCV infection group when compared with the non-HCV infection group. These findings agreed with the findings of Barakat et al. [11].

In our study, we found that there was no significant difference in the level of transferrin in the HCV-infected group HD and HCV-non-infected group HD; however, the values in both groups were more than the normal range. These findings were matched with a previous study carried out by Bharadwaj et al. [12].

In maintenance haemodialysis patients (MHD), inflammation was also a well-known feature; we found that serum CRP in both groups showed increased level than the known normal level of CRP. That was in accordance with the findings of Al-Amir et al. [13]. The MIS is a comprehensive scoring system that considered prospective short-term hospitalisation, mortality, nutrition, inflammation, and anaemia in maintenance haemodialysis patients [14].

A previous study of HD patients reported that the presence of active HCV infection, detected by molecular-based testing, is associated with certain clinical features that are suggestive of MICS [4].

We found that HCV infection was associated with a higher MIS score values (Table 6) which was in accordance with the findings of Tsai et al. [15].

Table 6 Correlation of the MIS with demographic and laboratory parameters
Full size table

Limitations

Not all patients agree to be in a research easily in addition, high price of elastography so could not be done.

Conclusion

The prevalence of malnutrition is higher in patients with positive hepatitis C virus than non-hepatitis C virus haemodialysis patients.

Recommendations

Routine nutritional screening and assessment at diagnosis of chronic kidney disease patients.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding on reasonable request.

Abbreviations

BMI:

Body mass index

CBC:

Complete blood count

CKD:

Chronic kidney disease

CRP:

C-reactive protein

ELISA:

Enzyme-linked immunosorbent assay

HCV:

Hepatitis C virus

MICS:

Malnutrition inflammation complex syndrome

MIS:

Malnutrition inflammation score

SPSS:

Statistical Package for the Social Sciences

References

  1. Mutimer D, Aghemo A, Diepolder H, Negro F, Robaeys G, Ryder S (2014) EASL clinical practice guidelines: management of hepatitis C virus infection. J Hepatol 60:392–420

    Article  Google Scholar 

  2. Pawlotsky J-M, Panel members, Alessio Aghemo, David Back, Geoffrey Dusheiko, Xavier Forns et al (2015) EASL recommendations on treatment of hepatitis C. J Hepatol 63:199–236

    Article  Google Scholar 

  3. Norberto P, Dario C, Bikbov B, Giuseppe R (2009) Hepatitis C infection and chronic renal diseases. Clin J Am Soc Nephrol 4:207–220

    Article  Google Scholar 

  4. Kalantar-Zadeh K, Miller LG, Daar ES (2005) Diagnostic discordance for hepatitis C virus infection in hemodialysis patients. Am J Kidney Dis 46:290–300

    Article  Google Scholar 

  5. Kuhlmann M.K. and Levin N.W. Interaction between nutrition and inflammation in hemodialysis patients. Contrib Nephrol 2005 l; 149:200-207.

  6. Ekramzadeh M, Sohrabi Z, Salehi M, Ayatollahi M, Hassanzadeh J, Geramizadeh B et al (2014) Adiponectin as a novel indicator of malnutrition and inflammation in haemodialysis patients. Iran J Kidney Dis 7(4):304

    Google Scholar 

  7. Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L (2004) Subjective global assessment in chronic kidney disease. J Ren Nutr 14(4):191–200

    Article  Google Scholar 

  8. Abdalla EAM, Shabban KMA, Elkhidir IM (2016) Haemodialysis patients at dialysis centers in Khartoum State – Sudan. OSR-JDMS 16(3):83–88

    Article  Google Scholar 

  9. Boubaker K, Mahfoudhi M, Battikh A, Bounemra A, Maktouf C, Kheder A (2015) Higher endogenous erythropoietin levels in hemodialysis patients with hepatitis C virus infection and effect on anemia. Open Journal of Nephrology 5:29–34

    Article  CAS  Google Scholar 

  10. Wai CT (2013) and his colleagues. Correcting thrombocytopenia in patients with liver diseases: a difficult hurdle. J Gastroenterol Hepatol 28:207–221

    Article  Google Scholar 

  11. Barakat AA, Nasr FM, Metwaly AA, and Morsy S Eldamarawy M. Atherosclerosis in chronic hepatitis C virus patients with and without liver cirrhosis. Egypt Heart J 2017 3 l; 69(2): 139-147.

  12. Bharadwaj S, Ginoya S, Tandon P, Tushar D, Gohel TD, Guirguis J et al (2016) Malnutrition: laboratory markers vs nutritional assessment. Gastroenterology Report 4:272–280

    PubMed  PubMed Central  Google Scholar 

  13. Al-Amir MA, Hassan AA, Elshafie SM, ZeinElabdin HM, Taha SA (2017) The relationship between anemia, serum hepcidin levels, and chronic hepatitis C in chronic hemodialysis patients. Egypt J Intern Med 29(6):112

    Google Scholar 

  14. Ho LC, Wang HH, Peng YS, Chiang CK, Huang JW, Hung KY, Hu FC, Wu KD (2008) Clinical utility of malnutrition inflammation score in maintenance hemodialysis patients: focus on identifying the best cut-off point. Am J Nephrol 28:840–846

    Article  Google Scholar 

  15. Tsai H-B, Chen P-C, Liu C-H, Hung P-H, Chen M-T, Chiang C-K, Kao J-H et al (2012) Association of hepatitis C virus infection and malnutrition–inflammation complex syndrome in maintenance hemodialysis patients. Nephrol Dial Transplant 7:1176–1183

    Article  Google Scholar 

Download references

Acknowledgements

Much gratitude is paid to all persons who helped in this work.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Fardous Abdel Fattah Ramadan, Nancy Abdel Fattah Ahmed & Salah Elshahat Aref

  2. Dialysis Unit, Sherbeen Hospital, Dakalia, Egypt

    Mona Abdel Ghani El Husseini

Authors
  1. Fardous Abdel Fattah Ramadan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy Abdel Fattah Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Salah Elshahat Aref
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mona Abdel Ghani El Husseini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have read and approved the manuscript. FAFR: manuscript review, design, and final revision. NAFA: idea of the study, manuscript editing, publishing, and follow-up (CA). SESA: laboratory studies. MAGH: literature search, clinical, statistics, and data collection.

Corresponding author

Correspondence to Nancy Abdel Fattah Ahmed.

Ethics declarations

Ethics approval and consent to participate

Study protocol was investigated and approved by the Medical Ethics Research Team, Faculty of Medicine, Mansoura University. Every case, after guaranteeing privacy, has given informed written consent (code number MS/ 906).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramadan, F.A.F., Ahmed, N.A.F., Aref, S.E. et al. Malnutrition inflammation index in chronic haemodialysis patients with or without hepatitis C virus infection. Egypt Liver Journal 10, 20 (2020). https://doi.org/10.1186/s43066-020-00026-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s43066-020-00026-y

Keywords

  • HCV
  • CKD
  • MIS