Effect of chronic hepatitis C on serum zinc and its relation as a cofactor to cognitive impairment and nutritional status in hemodialysis patients

Abstract

Background and aim The prevalence of hepatitis C virus (HCV) infection among dialysis patients is higher than in the general population. The prevalence of cognitive impairment (CI) is common among hemodialysis (HD) patients. Also patients with end-stage liver disease are vulnerable to cognitive dysfunction. Malnutrition and inflammation are common occurrences in maintenance HD patients. About 40–78% of individuals on HD suffer from hypozincemia. Zinc deficiency has been observed with high prevalence in liver cirrhosis. This study was carried out to assess the effect of chronic HCV on serum zinc level and its relation as a cofactor to CI and nutritional status in HD patients. Patients and methods The study involved 80 HD participants who were enrolled into two groups: group I: 40 HCV-positive HD patients (20 without liver cirrhosis and 20 with liver cirrhosis) and group II: 40 HCV-negative HD patients without liver cirrhosis. All participants were evaluated as regards detailed history and clinical examination, standardized mini-mental state examination (MMSE), malnutrition inflammation score (MIS), Child–Pugh classification, complete blood picture (CBP), prothrombin time, international normalized ratio, alanine aminotransferase, aspartate aminotransferase, serum albumin, bilirubin, blood urea, serum creatinine, Na, K, Ca, P, transferrin, ammonia, serum zinc level (predialysis and postdialysis session), virology including anti-HCV Ab, quantitative HCV PCR and hepatitis B surface antigen, Kt/V, fibrosis-4 score (FIB-4 score), and abdominal ultrasonography. Results We found that MMSE and zinc level were significantly lower and MIS was significantly higher in HCV HD patients with liver cirrhosis when compared with HCV HD patients without liver cirrhosis and HCV-negative HD patients. A positive significant correlation was found between zinc level and MMSE while there was a negative significant correlation between zinc level and MIS. Conclusion There may be an association between hypozincemia, CI, and malnutrition in HD patients especially those with chronic hepatitis C associated with liver cirrhosis.