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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 2  |  Page : 151-153
Hepatitis C Virus Infection in Hemodialysis Patients in Qatar


Hamad General Hospital, Doha, Qatar

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   Abstract 

To evaluate the prevalence of hepatitis C virus (HCV) infection and the histopathological aspects of this infection among regular hemodialysis patients, we followed 130 patients on regular dialysis screened for HCV antibodies by enzyme-linked immunosorbent assay (ELISA). Confirmatory testing was done using a second generation recombinant immunosorbant assay (RIBA). Fifty eight patients (44.6%) were antibody positive at the start of the study. There was a significant relationship between the presence of anti-HCV antibody and the increased period on dialysis (54.3 months in the sero-positive group, compared to 22.2 months in the sero­negative group, (P < 0.001). There was no statistical correlation with the history of blood transfusion or the serum iron level. Liver biopsies in eight sero-positive patients with abnormal liver enzymes showed chronic active hepatitis in six and chronic persistent hepatitis in two cases. Such findings of gross hepatic involvement in anti-HCV positive hemodialysis patients strongly support the arguments for antiviral therapy with Interferon in these patients, in the attempt to prevent further hepatic damage, before they receive renal allografts.

Keywords: Hepatitis C Virus, Hemodialysis, Qatar.

How to cite this article:
Abboud O, Rashid A, Al-Kaabi S. Hepatitis C Virus Infection in Hemodialysis Patients in Qatar. Saudi J Kidney Dis Transpl 1995;6:151-3

How to cite this URL:
Abboud O, Rashid A, Al-Kaabi S. Hepatitis C Virus Infection in Hemodialysis Patients in Qatar. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jul 5];6:151-3. Available from: http://www.sjkdt.org/text.asp?1995/6/2/151/40857

   Introduction Top


The importance of hepatitis C virus (HCV) the field of Nephrology is being increasingly recognized, especially in the hemodialysis patients because of its high prevalence of infection, and the potential morbidity it may cause in such fragile population [1],[2],[3] . Certain aspects of the disease in the hemodialysis patients are yet to be fully elucidated i.e. its contribution to the produce in tion of chronic liver disease, which has its bearing on the morbidity and mortality in the hemodialysis population, on the suitability of those patients as future renal allograft recipients, and the ability of antiviral therapy..apply to halt or resolve the hepatic pathology. The objective of this study was to estimate the incidence of HCV infection and to evaluate the histopathologic aspects of the HCV infection among patients on regular hemodialysis treatment.


   Patients and Methods Top


Hemodialysis in Qatar is done only in the dialysis unit at Hamad General Hospital. Hepatitis B surface antigen positive patients are isolated in a separate room. Chemical disinfection of the dialysis machines using bleach is performed between dialysis sessions, and formaldehyde treatment on weekends. A total of 130 patients on regular hemodialysis were enrolled into this study. Evaluation included detailed history, clinical examination, monthly liver enzymes and six monthly serum iron, ferritin, hepatitis B and C serology. Blood samples were tested for presence of anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA), and the confirmatory testing was done using a second generation recombinant immunosor-bant assay (RIBA). Liver biopsies were performed in eight patients who had high levels of alanine aminotransferase (ALT) and positive anti­HCV antibody; all were negative for hepatitis B surface antigen.


   Results Top


In this study 58 patients were positive fox anti-HCV antibody, 21 of them had high liver enzymes. A history of receiving blood transfusion was positive in 39 (67%) patients. In the 72 patients with negative HCV antibodies, the history of previous blood transfusion was positive in 45 (62%) of them. The period on dialysis ranged from 10 to 142 months (with a mean of 58 months) in the seropositive group compared to a range of 7­94 months (with a mean of 22 months) in the seronegative group (P value < 0.001). The mean serum iron level was 10.55 in the HCV seropositive group versus 8.8 umol/1 in the seronegative group, (P value < 0.055). The histopathological assessment of the liver biopsies showed chronic active hepatitis in six cases, and chronic persistent liver hepatitis in the two other cases. All the eight patients were started after the liver biopsies on interferon therapy.


   Discussion Top


The high prevalence rate of HCV antibodies positivity in our study was comparable to that found in other countries in the region like Saudi Arabia [3] , and appreciably higher than that in the European countries he., 3.9% in Glasgow [4] and 12% in Southern Sweden [5] . The main risk factor significantly correlated with this high prevalence in Qatar was the increased duration on dialysis of the HCV seropositive patients, as was reported elsewhere [6],[7] . There was no statistical correlation of the HCV seropositivity with the history of blood transfusions, or serum iron levels. The importance of the histopathological assessment of the hepatic involvement using the liver biopsies in the HCV antibody positive hemodialysis patients was further emphasized by the poor correlation between the biochemical, or gerological investigations and the severity of liver disease. In one report the aminotransferases were persistently normal in three patients with severe liver disease and were elevated in ten patients with only mild histopathological changes [8] . There was also doubt of the ability of the polymerase chain reaction (PCR), used to detect plasma HCV RNA, to predict the histological severity of the disease [8] . Due to the possibility of inducing rejection episodes in the anti-HCV renal allograft recipients treated with interferon [9] , it appeared wiser to treat such patients in the pre-transplant period while they are still on dialysis therapy. The literature on this aspect of therapy is very scarce, but suggests a beneficial effect in the dialysis patients [10] . Being convinced of the serious consequences of HCV on the liver, we commenced our patients with the histological evidence of hepatic involvement on Interferon therapy. It is still early to report the results of such treatment.

 
   References Top

1.Camps DH, Azcona S, Bertola S, et al. The prevalence of anti-hepatitis virus C antibodies in chronic hemodialysis patients. Medicina B Aires 1992;52:(6):511-5.  Back to cited text no. 1    
2.Fathalla SE, Al-Jama AA, Badawy MS, et al. Prevalence of hepatitis C virus infection in the Eastern Province of Saudi Arabia by RE-DNA second generation and supplemental EIA tests. Saudi Med Journal 1994;15:281-5.  Back to cited text no. 2    
3.Huraib S, Al Rasheed R, Aldrees A, Al­Jefry M, Arif M, Faleh FA. High prevalence and risk factors for hepatitis C in Saudi Arabia. A need for new strategies in dialysis practice (Abstract). Saudi Kidney Dis Transplant Bull 1993;4:(S1):73.  Back to cited text no. 3    
4.Mclntyre PG, MeCruden EA. Dow BC, et al. Hepatitis C virus infection in renal dialysis patients in Glasgow. Nephrol Dial Transplant 1994;9:291-5.  Back to cited text no. 4    
5.Nordenfelt E, Lofgren B, Widell A, et al. Hepatitis C virus infection in hemodialysis patints in Southern Sweden: epidemiological, clinical and diagnostic aspects. J Med Virol 1993;40:266-70.  Back to cited text no. 5    
6.Irie Y, Hayashi H, Yokozeki K, Kashima T, Okuda K. Hepatitis C infection unrelated to blood transfusion in hemodialysis patients. J Hepatol 1994;20:557-9.  Back to cited text no. 6  [PUBMED]  
7.Kumar H, Naqvi SA, Ahmed A, Hamid S. Hepatitis C virus antibodies (anti-HCV) in hemodialysis vs no dialysed patients. J Pak Med Assoc 1994;44:28-30.  Back to cited text no. 7  [PUBMED]  
8.Alfurayh O, Sobh M, Buali A, -et al. Hepatitis C virus infection in chronic hemodialysis patients, a clinicopathologic study. Nephrol Dial Transplant 1992;7:327-32.  Back to cited text no. 8    
9.Caramelo C, Ortiz A, Aguilera B, et al. Liver disease patterns in hemodialysis patients with antibodies to hepatitis C virus. Am J Kidney Dis 1993;22:822-8.  Back to cited text no. 9    
10.Rhodes J, Jones DH, Bleehen NM. Increased expression of human monocyte HLA-DR antigens and Fc gamma receptors in response to human interferon in vivo. Clin Exp Immunol 1983;53:739-43.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Omer Abboud
Hamad General Hospital, Doha
Qatar
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PMID: 18583855

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
 

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