Increase Serum Tumor Necrosis Factor Alpha decreased Serum Cholesterol Level, but not Albumin, in Hemodialysis Patients with Non-Fibrotic Hepatitis C Infection

Rudi Supriyadi; Nenny Agustanti; Marcella Adisuhanto

doi:10.3889/oamjms.2021.6397

Authors

Rudi Supriyadi Department of Internal Medicine, Division of Nephrology and Hypertension, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0002-7211-2365
Nenny Agustanti Department of Internal Medicine, Division of Gastroenterology and Hepatology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
Marcella Adisuhanto Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0002-4722-0567

DOI:

https://doi.org/10.3889/oamjms.2021.6397

Keywords:

Albumin, Cholesterol, Hemodialysis, Hepatitis C, Inflammation, TNF-α

Abstract

BACKGROUND: Hepatitis C infection could increase the morbidity and mortality of chronic kidney disease patients on hemodialysis by enhancing the inflammatory process. Tumor Necrosis Factor-alpha (TNF-a) is the main regulator of the inflammatory cascade, which could induce malnutrition and suppress cholesterol and albumin production in the liver.

AIM: Therefore, this study aimed to determine the correlation between serum TNF-a level with serum albumin and cholesterol levels in chronic kidney disease patients on hemodialysis with and without hepatitis C infection.

METHODS: This research was an analytical cross-sectional study. The sample of this study consisted of patients undergoing routine hemodialysis at Dr. Hasan Sadikin Hospital, Bandung, in February 2020. The sample selection was using a random sampling method and analyzed with the Spearman rank correlation test.

RESULTS: One hundred nineteen patients were divided into two groups, with hepatitis C infection (n=53) and without hepatitis C infection (n=66). The median value of serum TNF-α _was higher in the hepatitis C infection group compared to the group without hepatitis c infection (31.86 pg/ml vs 11.71 pg/ml, p <0.001). There was a correlation between serum TNF-α _and cholesterol in the hepatitis C infection (r = -0.246; p = 0.039) and without hepatitis c infection group (r = -0.256; p = 0.022). After adjusting with the duration of hemodialysis, this association was found to be significant in patients without Hepatitis C infection (p = 0.02) and borderline significant in patients with Hepatitis C infection (p = 0.09). There was no correlation between TNF-α _with albumin in both hepatitis C infection group (r = 0.082; p = 0.281) and without hepatitis C infection (r = -0.168; p = 0.094).

CONCLUSION: Serum TNF-α _negatively correlates with cholesterol levels in chronic kidney disease patients on hemodialysis with and without hepatitis C infection. However, there was no correlation between TNF-α _and albumin level in both groups.

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