MP635EFFECT OF HEPATITIS C SEROPOSITIVITY ON COGNITIVE FUNCTIONS IN PREVALENT HEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: Cognitive functions impairment is frequent in prevalent hemod‐ialysis (HD) patients. Hepatitis C seropositivity is not uncommon in prevalent HD patients, most of the cases are asymptomatic and belong to grae A of Child classification. though such cases are clinically silent, many may habor varible degrees of cognitive dyfunction , the so called subclinical hepatic encephalopathy. No previous attempts in the literature have tried to study the possible effect of asymptomatic hepatitis C seropositivity (Child grade A) on cognitive functions in prevalent HD patients. Thus the aim of our study is to assess cognitive functions in Child grade A hepatitis C seropositive prevalent HD patients. Methods: Twenty two hepatitis c seropositive (Chid grade A) stable prevalent HD patient (Group A) were randomly selected from our HD unit. Another group of twenty three hepatitis c seronegative stable HD patients (Group B) were also randomly selected from our HD unit. Both groups were similar in age, sex, BMI, and duration of hemod‐ialysis. Diabetics, those with CKD 2ry to systemic or heridetary diseases as well as those on medications that may affect cognitive functions were excluded from the study. A third group (Group C) of twenty five apparently healthy(hepatitis c seronegative) persons of similar age, sex and BMI were also randomly selected. Members of the three groups were studied by CBC, routine biochem‐istry fasting lipogram, PTH(Intact), Ultrasensitive CRP, URR% (for dilysis patients), as well asassessment of mental functions using Mini mental test, Trail making test(A&B) Verbal paired association test (1&2), Digital span forward and backward tests, Wechesler adult IQ test, and Benton visual retention test. Intimal medial thickness of the Internal carotid artery was also assessed by duplex ultrasound. Results: We did not detect significant difference between both dialysis groups and any of the studied laboratory parameters. However, we detected signicantly more frequent and severe impairment of Mini‐mental test(assessing global mental functions)in seropositve group(A)(10 out of 22 patients i.e. 45.4%) compared to seronegative group (B)(3 out of 23 patients i.e. 13%). We also detected signifcant impairment of Trail making test A(measuring visual attention) and Trail making test B (measuring psychomotor speed), and borderline significant impairment of Digital span B score (measuring working memory) in seropositive group compared to seronegative group. We did not detect significant differences between the 2 dialysis groups in the other psychomotor tests measured nor in the carotid intimal thickness. Conclusions: It may be concluded that though our hepatitis C seropositive HD patients were clinically asymptomatic(Child grade A), yet there were more frequent and severe impairment of global and some psychmotor and memory functions compared to hepatitis C seronegative HD patients which may reflect subclinical encephalopathy state in hepatitis C seropositive prevalent HD patients. It may be also suggested that treatment of hepatitis C infection in HD patients is necessary even for asymptomatic mild cases.