HEPATITIS C VIRUS AND CHRONIC PROGRESSIVE KIDNEY DISEASE GUIDELINES FOR DETECTION, EVALUATION, TREATMENT AND PREVENTION OF INFECTION TRANSMISSION IN HEMODIALYSIS UNITS; PROCEDURE FOR INFECTED PATIENTS-CANDIDATES FOR KIDNEY TRANSPLANTATION AND PROCEDURE FOR PATIENTS SUSPECTED OF HCV INFECTION-RELATED KIDNEY DISEASE

Infekcije s virusom hepatitisa C (HCV) pripadaju u relativno česte komplikacije kod bolesnika koji se dugotrajno liječe dijalizom. U postupniku su prikazane smjernice za serološku i molekularnu dijagnostiku hepatitisa C u bolesnika s kroničnom bolesti bubrega, preporuke za liječenje HCV infekcije u tih bolesnika i prevenciju prijenosa HCV u jedinicama za hemodijalizu. U posebnom su poglavlju navedene upute za postupak s bolesnicima koji su inficirani s HCV prije i nakon transplantacije bubrega. U posebnom poglavlju dane su smjernice za liječenje bolesti bubrega koje su posljedica HCV infekcije.Hepatitis C virus (HCV) infection is a relatively frequent complication among long-term dialysis patients. The paper presents guidelines for serologic and molecular diagnosis of hepatitis C in patients with chronic kidney disease, recommendations for the treatment of HCV infection in these patients and the prevention of transmission of HCV in hemodialysis units. A separate chapter provides guidance on the management of patients who are infected with HCV before and after kidney transplantation, and guidelines for the treatment of renal disease resulting from HCV infection

Bone mineral density in adolescents with chronic kidney disease: a follow-up study

Cilj istraživanja jest odrediti promjenu koštane gustoće u bolesnika adolescentne dobi s kroničnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veličine skeleta na koštanu gustoću. U ispitivanju je sudjelovalo 30 bolesnika, prosječne dobi 13,5±3,5 godina. Svim ispitanicima denzitometrijski je određena mineralna gustoća kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su određeni kalcij, fosfor i PTH u serumu i izračunat je klirens kreatinina. Prosječno vrijeme između početnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. Utvrđenje značajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoća skeleta na kralježnici i cijelom skeletu je također značajno porasla između dva mjerenja, ali nakon korekcije prema visini i težini, taj porast više nije bio značajan. Zato je kod djece s kroničnim zatajenjem bubrega potrebno izvršiti korekciju koštane gustoće u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity

Bone mineral density in adolescents with chronic kidney disease: a follow-up study

Cilj istraživanja jest odrediti promjenu koštane gustoće u bolesnika adolescentne dobi s kroničnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veličine skeleta na koštanu gustoću. U ispitivanju je sudjelovalo 30 bolesnika, prosječne dobi 13,5±3,5 godina. Svim ispitanicima denzitometrijski je određena mineralna gustoća kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su određeni kalcij, fosfor i PTH u serumu i izračunat je klirens kreatinina. Prosječno vrijeme između početnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. Utvrđenje značajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoća skeleta na kralježnici i cijelom skeletu je također značajno porasla između dva mjerenja, ali nakon korekcije prema visini i težini, taj porast više nije bio značajan. Zato je kod djece s kroničnim zatajenjem bubrega potrebno izvršiti korekciju koštane gustoće u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity

OUTCOME OF RENAL TRANSPLANTATION IN PATIENTS WITH CHRONIC VIRUS HEPATITIS

Cilj rada bio je pokazati rezultate liječenja transplantacijom bubrega bolesnika s terminalnim zatajenjem funkcije bubrega liječenih dijalizom s kroničnim C/B virusnim hepatitisom. Retrospektivno smo analizirali rezultate transplantacijskog liječenja tih bolesnika od 1985. do 2009. godine u KBC-u Zagreb: funkciju i preživljenje transplantiranog bubrega, preživljenje bolesnika, jetrenu funkciju, te komplikacije transplantacijskog liječenja: epizode akutnog odbacivanja, pojavnost dijabetesa melitusa, te proteinurije. Analizirali smo podatke transplantacijskog liječenja 91 bolesnika, od toga 50 muškaraca i 41 žene, prosječne dobi 40,9 godina, prethodno liječenih dijalizom 7,8 godina, a prosječno praćenje nakon transplantacije iznosilo je 7,3 godine. Najčešće dijagnoze koje su dovele do kroničnog zatajenja funkcije bubrega bile su: kronični glomerulonefritis, refluks nefropatija, tubulointersticijski nefritis, hipoplazija/aplazija bubrega i policistična bolest bubrega. 59,5% bolesnika imalo je dobru funkciju transplantiranog bubrega (serumski kreatinin do 200 umol/L). Jednogodišnje preživljenje transplantiranog bubrega iznosilo je 93%, 5-godišnje 64%, 10-godišnje 39%. Jednogodišnje preživljenje bolesnika iznosilo je 98%, 5-godišnje 72%, 10-godišnje 42%. Uredne vrijednosti jetrenih enzima (AST, ALT) imalo je 61% bolesnika, dok su povišene vrijednosti zabilježene u 39% bolesnika. Epizode akutnog odbacivanja transplantiranog bubrega imalo je 56% bolesnika. Proteinurija je zabilježena u 27% bolesnika, dijabetes melitus u 18%, dok je povišene vrijednosti arterijskog tlaka imalo 66% bolesnika. Bolesnici s kroničnim virusnim C/B hepatitisom liječeni transplantacijom bubrega imali su lošije preživljenje transplantata, bolesnika, lošiju funkciju transplantata no bolesnici bez kroničnog virusnog hepatitisa. Razlozi su veća učestalost epizoda akutnog odbacivanja transplantiranog organa, a prema podacima iz literature i veća učestalost infekcija (bakterijske infekcije, sepse), češće i dulje hospitalizacije, veća učestalost malignih bolesti, te češća kronična alograft nefropatija. Najčešći uzroci smrti bili su kardiovaskularne i cerebrovaskularne bolesti, te jetrena ciroza.The objective is to present results of renal transplantation in patients with end-stage renal disease and chronic virus C/B hepatitis. We retrospectively reviewed outcome of transplantation in patients having received renal allograft from 1985 to 2009 at Zagreb University Hospital Center: graft function, graft and patient survival, hepatic function, and complications of transplantation, i.e. episodes of acute rejection, manifestation of diabetes mellitus, and proteinuria. There were 91 patients, 50 men and 41 women, mean age 40.9. Patients were previously treated with dialysis for 7.8 years, with the mean follow-up after transplantation of 7.3 years. The most frequent diagnoses of end-stage renal disease were chronic glomerulonephritis, reflux nephropathy, tubulointerstitial nephritis, renal hypoplasia/aplasia, and polycystic renal disease. Good graft function (creatinine 200 μmol/L) was recorded in 59.5% of patients. One-year, 5-year and 10-year graft survival was 93%, 64% and 39%, and 1-year, 5-year and 10- year patient survival after transplantation was 98%, 72% and 42%, respectively. Normal values of liver chemistry (AST, ALT) were found in 59.5% and elevated values in 40.5% of patients. Episodes of acute rejection occurred in 56% of patients. Proteinuria was recorded in 27%, diabetes mellitus in 18% and elevated blood pressure in 66% of patients. Patients with chronic C/B virus hepatitis having undergone renal transplantation had worse graft function and worse graft and patient survival than patients without chronic hepatitis. The most common causes of death were cardiovascular diseases, cerebrovascular diseases and cirrhosis hepatitis

Henoch-Schönlein purpura nephritis in children: experience of the two tertiary care centers for pediatric and adolescent rheumatology of the Republic of Croatia from 2006 to 2017

Cilj istraživanja: Valjalo je utvrditi vrste bubrežnih komplikacija, indikacije za biopsiju, načine liječenja te moguće ishode u bolesnika s Henoch-Schönleinovim purpurnim nefritisom (HSPN). Ispitanici i metode: Retrospektivna analiza podataka bolesnika s Henoch Schönleinovom purpurom (HSP) liječenih u Klinikama za pedijatriju Kliničkoga bolničkog centra Zagreb i Kliničkoga bolničkog centra Split, u razdoblju od 2006. do 2017. godine, u kojih se razvila bubrežna bolest prema kriterijima EULAR/PRINTO/PRES-a. Rezultati: Od 378 bolesnika s HSP-om u 81 (21,4%) razvila se bubrežna bolest, u 43 dječaka (53,1%) i 38 djevojčica (46,9%), s medijanom dobi 8,4 godine (2,5 – 16,8). Uočen je statistički značajan porast broja bolesnika s HSP-om tijekom jeseni i zime. Dob bolesnika pri dijagnozi pokazala se kao mogući prognostički čimbenik bubrežne bolesti. S povišenjem dobi bolesnika veći su izgledi za razvoj bubrežne bolesti, pri čemu se u dobi od 1 do 17 godina sa svakom godinom vjerojatnost razvoja nefritisa povećava u prosjeku oko 2,25%. Jednak broj bolesnika imao je istodobno hematuriju i proteinuriju (44,45%) te izoliranu hematuriju (44,45%), a njih samo 11,1% izoliranu proteinuriju. Biopsija bubrega obavljena je u 37 bolesnika (45,7%), a najviše bioptiranih bolesnika bilo je iz skupine s istodobnom hematurijom i proteinurijom (70,3%). Djeca s izoliranom hematurijom odnosno s izoliranom proteinurijom najčešće su liječena glukokortikoidima, dok su djeca s istodobnom hematurijom i proteinurijom najčešće liječena glukokortikoidima i inhibitorima enzima koji konvertira angiotenzin. Imunosupresivnim lijekovima liječeno je ukupno 16% bolesnika, među kojima je najviše onih iz skupine s istodobnom hematurijom i proteinurijom (69,2%). Samo se u jednog bolesnika (1,2%) razvilo bubrežno zatajenje uz potrebu za primjenom dijalize, dok je ishod ostalih ocijenjen kao dobar. Zaključak: Najvažniji čimbenik konačnog ishoda bolesnika s HSP-om jesu bubrežne komplikacije. Da bi se ovi bolesnici mogli optimalno liječiti, potrebno je donijeti konsenzus o indikacijama za biopsiju bubrega u HSPN-u te validirati postojeće patohistološke klasifikacije radi utvrđivanja koja od njih najbolje korelira s nepovoljnim ishodom bolesti.Aim: To determine types of renal complications, indications for biopsy, treatment methods and possible outcomes in patients with Henoch-Schönlein purpura nephritis. Patients and methods: Retrospective analysis of medical data of HSP patients treated at the Department of Paediatrics, University Hospital Centre Zagreb, and the Department of Paediatrics, University Hospital Centre Split, during the period from 2006 to 2017, who developed kidney disease according to EULAR/PRINTO/PRES criteria. Results: Out of 378 patients diagnosed with HSP, 81 (21.4%) developed kidney disease, out of whom 43 boys (53.1%) and 38 girls (46.9%), with the median age 8.4 years (2.5 16.8).. A statistically significant increase of patients with HSP was during autumn and winter. There is a greater chance of nephritis with the increase of patients age at diagnosis. For every year (from 1 to 17 years) the chances increase by around 2.25%. Equal number of patients, 44.45%, had both hematuria and proteinuria or isolated hematuria, and only 11.1% isolated proteinuria. Renal biopsy was performed in 37 patients (45.7%), and most biopted patients were from concurrent hematuria and proteinuria group (70.3%). Children with isolated hematuria or with isolated proteinuria were most often treated with corticosteroids while children with hematuria and proteinuria were most often treated with corticosteroids and angiotensin- -converting enzyme inhibitors. Immunosuppressives were used in 16% of the patients, including most of those in the group with concurrent hematuria and proteinuria (69.2%). Only one patient (1.2%) developed renal insufficiency with the need for dialysis, while the outcome of the others was evaluated as good. Conclusion: Renal complications are the most important factor in the outcome of patients with HSP. For the optimal treatment of these patients it is necessary to bring consensus about the indications for kidney biopsy in HSP, and also to validate the existing pathohistological classification to affirm which one best correlates with the adverse outcome of the disease

VIRAL HEPATITIS - CROATIAN CONSENSUS STATEMENT 2013

Hrvatske konsenzus konferencije o virusnim hepatitisima održane su 2005. i 2009. g. (1). S obzirom na brojne nove spoznaje o epidemiologiji, dijagnostici i liječenju virusnih hepatitisa (poglavito kroničnog hepatitisa C genotipa 1) u protekle četiri godine, 28. veljače 2013. g. održana je nova Hrvatska konsensus konferencija o virusnim hepatitisima u Zagrebu. Sažeti tekst ove Hrvatske konsenzus konferencije o virusnim hepatitisima sadrži prikaz novih spoznaja o epidemiologiji virusnih hepatitisa, serološkoj i mo¬lekularnoj dijagnostici virusnih hepatitisa, određivanju polimorfizma promotora gena za IL-28, procjeni stadija fibroze, algoritmu dijagnostičkog praćenja bolesnika, liječenju kroničnog hepatitisa C (genotipovi 1-6) i hepatitisa B, liječenju specijalnih populacija (djeca, bolesnici na dijalizi, bolesnici liječeni transplantacijom, osobe s HIV/HCV koinfekcijom) i nuspojavama liječenja.Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fi¬brosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treat¬ment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects

VIRAL HEPATITIS - CROATIAN CONSENSUS STATEMENT 2013

Hrvatske konsenzus konferencije o virusnim hepatitisima održane su 2005. i 2009. g. (1). S obzirom na brojne nove spoznaje o epidemiologiji, dijagnostici i liječenju virusnih hepatitisa (poglavito kroničnog hepatitisa C genotipa 1) u protekle četiri godine, 28. veljače 2013. g. održana je nova Hrvatska konsensus konferencija o virusnim hepatitisima u Zagrebu. Sažeti tekst ove Hrvatske konsenzus konferencije o virusnim hepatitisima sadrži prikaz novih spoznaja o epidemiologiji virusnih hepatitisa, serološkoj i mo¬lekularnoj dijagnostici virusnih hepatitisa, određivanju polimorfizma promotora gena za IL-28, procjeni stadija fibroze, algoritmu dijagnostičkog praćenja bolesnika, liječenju kroničnog hepatitisa C (genotipovi 1-6) i hepatitisa B, liječenju specijalnih populacija (djeca, bolesnici na dijalizi, bolesnici liječeni transplantacijom, osobe s HIV/HCV koinfekcijom) i nuspojavama liječenja.Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fi¬brosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treat¬ment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects

Citokini u serumu bolesnika s kroničnim hepatititsom C na hemodijalizi [Cytokine serum levels in patients with chronic hepatitis C infection of regular hemodialysis]

Serum cytokine concentrations were determined in this study in hepatitis C virus infected patients on chronic hemodialysis. Aims of the study. To determine differences in serum cytokine concentrations between hepatitis C virus (HCV) positive and HCV-negative patients on chronic hemodialysis, and differences in serum cytokine levels between HCV-RNA positive and HCV-RNA negative patients. To investigate the relation between circulating cytokines and liver enzymes in HCV-positive patients and their role in pathogenesis of chronic HCV infection. To study the relation between viral load and cytokines in patients with chronic hepatitis C. Patients and methods. The study included 31 patients on chronic hemodialysis with chronic hepatitis C, and 28 HCV negative patients on chronic hemodialysis. 113 healthy subjects participated as controls. In the sera of patients and healthy controls, the concentrations of the following cytokines were determined on a microchip: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1β, IL-10, INF-, VEGF, EGF, MCP-1 and TNF- Results. The concentrations of proinflammatory cytokines IL-1β, TNF- , IL-8, IL-6, MCP-1 and VEGF were higher in subjects on hemodialysis than in healthy subjects. There was no significant difference in INF-, IL-10 and IL-1 levels. HCV positive patients had significantly higher concentrations of IL- 6, TNF- and IL-1β proinflammatory cytokines and lower IL-4 and EGF levels than healthy subjects. In comparison to HCV negative patients, HCV positive patients had higher IL-2 concentration. Hepatitis C genotype had no significant effect on the serum level of cytokines except on TNF- which was significantly reduced in patients with genotype 1a infection. The consequence of HCV infection is increased concentration of ALT and GGT transaminases, particularly in patients with confirmed viral RNA. CRP levels do not significantly differ between HCV positive and HCV negative patients. Different hepatitis C genotypes do not show selective effect on serum concentrations of transaminases, CRP and ferritin. Conclusion. Increased formation of Th2 cytokines was not observed in this study in HCV infected patients on chronic hemodialysis. The study did not confirm the hypothesis that the inability to eradicate chronic HCV infection in dialysis patients was the consequence of increased formation of Th2 cytokine

Cytokine serum levels in patients with chronic hepatitis C infection of regular hemodialysis

U ovom istraživanju mjerili smo serumske koncentracije citokina u bolesnika na kroničnoj hemodijalizi zaraženih hepatitisom C. Cilj istraživanja: utvrditi razlike u serumskim koncentracijama citokina izmedju HCV pozitivnih i HCV negativnih bolesnika na kroničnoj hemodijalizi te razlike u serumskim koncentracijama citokina između HCV-RNA pozitivnih i HCV-RNA negativnih bolesnika. Istražiti odnos između cirkulirajućih citokina i jetrenih enzima u HCV pozitivnih bolesnika te njihovu ulogu u patogenezi kronične HCV infekcije. Istražiti odnos virusnog opterećenja i citokina u bolesnika s kroničnim C hepatitisom. Bolesnici i metode: u istraživanje je uključeno 31 bolesnika na kroničnoj hemodijalizi s kroničnim hepatitisom C te 28 hepatitis C negativnih bolesnika na kroničnoj hemodijalizi. Kao kontrola poslužilo je 113 zdravih ispitanika. U serumu bolesnika i zdravih ispitanika određena je koncentracija slijedećih citokina na citokinskom mikročipu: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1β, IL-10, INF-, VEGF, EGF, MCP-1 i TNF- . Rezultati: U ispitanika na hemodijalizi povišena je koncentracija proupalnih citokina IL-1β, TNF-, IL-8, IL-6 i MCP-1 i VEGF u odnosu na zdrave ispitanike. Nije bilo značajne razlike u INF-, IL-10 i IL-1. Hepatitis C pozitivni bolesnici imaju značajno povišenu koncentraciju proupalnih citokina: IL- 6, TNF- i IL-1β a sniženu koncentraciju IL-4 i EGF u odnosu na zdrave ispitanike. U usporedbi s hepatitis C negativnim bolesnicima, hepatitis C pozitivni bolesnici imaju povišenu koncentraciju IL-2. Genotip hepatitisa C nema značajan učinak na serumske koncentracije citokina osim na TNF- , koji je značajno snižen u bolesnika zaraženih genotipom 1a. Zaraženost virusom hepatitisa C ima za posljedicu povišene koncentracije transaminaza ALT i GGT, naročito u bolesnika s dokazanom virusnom RNA. Razine CRP značajno se ne razlikuju između hepatitis C pozitivnih i hepatitis C negativnih bolesnika. Razni genotipovi hepatitisa C ne pokazuju selektivan učinak na serumske koncentracije transaminaza, CRP i feritina. Zaključak: U ovom istraživanju nije nađeno povećano stvaranje Th2 citokina u bolesnika zaraženih hepatitisom C na kroničnoj hemodijalizi. Istraživanje nije potvrdilo hipotezu da je nemogućnost iskorjenjivanja kronične HCV infekcije u bolesnika na dijalizi posljedica povećanog stvaranja citokina tipa Th2.Serum cytokine concentrations were determined in this study in hepatitis C virus infected patients on chronic hemodialysis. Aims of the study. To determine differences in serum cytokine concentrations between hepatitis C virus (HCV) positive and HCV-negative patients on chronic hemodialysis, and differences in serum cytokine levels between HCV-RNA positive and HCV-RNA negative patients. To investigate the relation between circulating cytokines and liver enzymes in HCV-positive patients and their role in pathogenesis of chronic HCV infection. To study the relation between viral load and cytokines in patients with chronic hepatitis C. Patients and methods. The study included 31 patients on chronic hemodialysis with chronic hepatitis C, and 28 HCV negative patients on chronic hemodialysis. 113 healthy subjects participated as controls. In the sera of patients and healthy controls, the concentrations of the following cytokines were determined on a microchip: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1β, IL-10, INF-, VEGF, EGF, MCP-1 and TNF- Results. The concentrations of proinflammatory cytokines IL-1β, TNF- , IL-8, IL-6, MCP-1 and VEGF were higher in subjects on hemodialysis than in healthy subjects. There was no significant difference in INF-, IL-10 and IL-1 levels. HCV positive patients had significantly higher concentrations of IL- 6, TNF- and IL-1β proinflammatory cytokines and lower IL-4 and EGF levels than healthy subjects. In comparison to HCV negative patients, HCV positive patients had higher IL-2 concentration. Hepatitis C genotype had no significant effect on the serum level of cytokines except on TNF- which was significantly reduced in patients with genotype 1a infection. The consequence of HCV infection is increased concentration of ALT and GGT transaminases, particularly in patients with confirmed viral RNA. CRP levels do not significantly differ between HCV positive and HCV negative patients. Different hepatitis C genotypes do not show selective effect on serum concentrations of transaminases, CRP and ferritin. Conclusion. Increased formation of Th2 cytokines was not observed in this study in HCV infected patients on chronic hemodialysis. The study did not confirm the hypothesis that the inability to eradicate chronic HCV infection in dialysis patients was the consequence of increased formation of Th2 cytokine