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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 363-367
Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran


1 Student's Research Committee, Urmia University of Medical Sciences, Urmia, Iran
2 Department of Microbiology, School of Paramedicine, Urmia University of Medical Sciences, Urmia, Iran
3 Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran

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Date of Web Publication9-Mar-2010
 

   Abstract 

Cytomegalovirus (CMV) causes infection in immunocompromised, transplant reci­pients and those who received blood transfusion frequently. Risk factors for primary CMV infec­tion are blood transfusion (including clotting factors, etc), recipients of infected transplants, hemo­dialysis and the frequency of dialysis in a week. This study aimed at determining the prevalence of cytomegalovirus (CMV) antibodies in end-stage renal disease (ESRD) patients who undergo hemodialysis. A cross-sectional study of hemodialysis patients in Urmia, Iran was undertaken in 2007. Sera of 84 Hemodialysis patients were investigated for CMV-specific immunoglobulin G (IgG). Forty-four (52%) patients were males. 65 patients (77.4%) were anti-CMV IgG positive and 6 (7.1%) were anti-CMV IgM positive. There was no relationship between the antibody titer and dialysis duration, or frequency of HD in a week. In conclusion, we recommend that every patient who has undergone hemodialysis receive blood products free of CMV if CMV negative to reduce the incidence and prevalence of CMV among HD patients.

How to cite this article:
Sepehrvand N, Khameneh ZR, Eslamloo HRF. Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran. Saudi J Kidney Dis Transpl 2010;21:363-7

How to cite this URL:
Sepehrvand N, Khameneh ZR, Eslamloo HRF. Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Nov 12];21:363-7. Available from: http://www.sjkdt.org/text.asp?2010/21/2/363/60216

   Introduction Top


Cytomegalovirus (CMV), is a herpes virus and endemic for all areas in the world. CMV infections are common and usually asympto­matic in otherwise healthy children and adults. [1] CMV has a worldwide distribution, infecting between 40% and 90% of adults, leading to lifelong latent infection. [2]

Recipients of solid-organ or hematopoietic­cell allografts and individuals with advanced AIDS and immunocompromised state, CMV is a well-known cause of serious morbidity, in­creasing health care cost and sometimes fatal infections. [3],[4] In United States of America an about 8,000 newborns have health problems each year as a result of congenital CMV in­fection. [5] Analysis conducted in the early 1990s revealed that the estimated costs to the U.S. healthcare system associated with congenital CMV infection were approximately $1.9 billion annually [6] , with a cost per affected child of over $300,000. [7]

Data regarding the prevalence of CMV anti­body among healthy people in Iran is scanty, but may reach up to 100 percent among donors and recipients, likely due to condensed popula­tion and socio-economic status. [8]

CMV causes infection in immunocompro­mised, transplant recipients and those who re­ceive blood transfusion frequently, such as he­modialysis patients. [9] Risk factors for primary CMV infection are blood transfusion (including clotting factors, etc.), recipients of infected trans­plants, hemodialysis, and the frequency of dia­lysis in a week. [9],[10]

Various studies demonstrated the appearance or elevation of anti-viral antibodies in hemodia­lysis patients. Also, CMV-related retinitis, he­patitis and pneumonitis have been reported. [11],[12],[13],[14],[15]

With this background, our study aimed to de­termine the prevalence of CMV antibodies in end-stage renal disease (ESRD) patients' under­going hemodialysis.


   Material and Methods Top


We undertook a cross sectional descriptive study of all of non-emergent patients, referred to hemodialysis section of Taleqani Hospital, Urmia, Iran.

Serum samples

A total of 84 serum samples were tested for CMV seroprevalence collected in 2007 from the hemodialysis patients Data was entered in a form including demographic information (age, sex, marital status, literacy status, residential status), data about the onset of renal failure and hemodialysis history.

Data was obtained by means of referring to medical records and personal interviews. Sera were identified with a unique identifier to en­sure that only one sample from any subject was tested. These identifiers were removed from the samples before testing, and the samples were coded.

Study population

Age of the patients ranged between 23 and 82 years of age and stratified into the following age groups: < 40, 40 to 69, > 70 years old. Ap­proximately equal numbers of males and fe­males were tested. Prevalence was calculated separately for each age group. All of HD pa­tients included had volunteered for the study and signed the informed consent.

Serological testing

Serum samples were tested for CMV-specific immunoglobulin G (IgG) using a CMV IgG en­zyme-labeled antigen test (Medac, Hamburg, Germany), and the results were interpreted according to the manufacturer's instructions. Samples with optical densities 10% or more below the cutoff were recorded as negative, those with optical densities between 10% be­low and 10% above the cutoff were equivocal, and all others were positive. If the sample's absorbance was within 10% of the cutoff level, the sample was retested and classified accor­ding to the retest result.

Statistical methods and ethical approval

The percentages of individuals with positive or negative results were determined for each age group and sex. SPSS software version 11.5 (Chicago, Illinois, USA) was used for the ana­lysis (by descriptive statistics and chi-square test). Ninety-five-percent confidence intervals were calculated where appropriate, and P values of < 0.05 were considered statistically signifi­cant. Ethics approval was obtained from the Human Research Ethics Committee of the Ur­mia University of Medical Sciences.


   Results Top


Mean age of the study population was 56 ± 16.18 years (23-82 years).

Only 13 patients (15.5%) were seronegative for CMV, 65 (77.4%) had previous infection, and finally 6 patients (7.1%) had a secondary or an active infection.

Most of HD patients included in our study were 40-69 years old (49 subjects, 58.9%) and majority of them were positive for CMV. 44 (52.3%) were male and 40 (47.6%) were fe­male and CMV prevalence is shown in [Figure 1]. 64 patients (76.1%) were residing in the city and 20 (23.8%) were living in rural areas. 52 of Urmia's urban dwellers and 18 of patients living in villages near Urmia were seropositive for CMV. 4 of city residents and 2 of village residents had active infection.

73 (86.9%) of patients were married, 8 (9.5%) were single and 3 (3.5%) were widowed wo­men. 60 of married patients and all of single (8 patients) or widowed group (3 patients) were seropositive for CMV. Only 6 of married pa­tients had secondary or active infection.

CMV prevalence according to literacy is shown in [Table 2]. Majority of the patients 77 (91.6%) were dialyzed 3-4 times a week with a sero­prevalence of CMV of 66 (85.7%) of patients with 3-4 sessions and 5 (71.4%) of patients with 1-2 sessions.

Majority of the patients 61 (72.6%) were un­dergoing HD < 5 years and 10 (11.9%) for more than 10 years. According to duration of hemodialysis 49 (80.3%) and 10 (100%) res­pectively were positive for CMV. Patients who were ESRD for more than 10 years, were seropositive for CMV. 3 of < 5 years group, 1 of 5-10 years group, and 2 of > 10 years group had acute CMV infection.

76 (90.4%) of patients underwent hemodia­lysis for less than 5 years. 3 patients with less than 2 years and 2 between 2-5 years of HD had acute CMV infection.


   Discussion Top


This study was designed to determine the pre­valence of cytomegalovirus (CMV) antibodies in end-stage renal disease (ESRD) patients' un­dergoing hemodialysis.

In this study a high prevalence, 65 patients (77.4%) were anti-CMV IgG positive and 6 (7.1%) were anti-CMV IgM positive was found. There was no relationship between the anti-body titer and dialysis duration, or frequency of HD in a week.

Risk factors for primary CMV infection are blood transfusion (including clotting factors, etc.), recipients of infected transplants, hemo­dialysis, and the frequency of dialysis in a week. [9],[10]

Various studies demonstrated the appearance or elevation of anti-viral antibodies in hemodia­lysis patients. Also, CMV-related retinitis, he­patitis and pneumonitis have been reported. [11],[12],[13],[14],[15]

Ikram H found that CMV infection didn't va­ry with socio-economic status or length of time on hemodialysis. [11] But in a study by Abbas MM et al from Cairo, high percentage of posi­tivity for CMV antibodies in patients under­going HD was noticed which also correlated to the number of the dialysis sessions. [14] Similarly, Spisni C and his colleagues noted 67% of HD and CAPD patients having IgG CMC positi­vity. [16]

Our results are similarly high to our local study by AminZadeh Z et al from Tehran (91% seropositivity and 18.5% acute CMV infec­tion). [17] In their study also, there was no signi­ficant relationship between age, sex, literacy status, residential status, cause of renal failure, sessions of HD per week, duration of HD, and antibody titer of CMV in our study. These re­sults do suggest a wide differences in the lite­rature also as shown by Abbas and study by Ikram. [11],[14]

As mentioned in literature, blood transfusion is one of the major routes of CMV transmi­ssion. Since determination of CMV antibodies is not a part of the routine laboratory tests in blood transfusion centers yet and a high sero­prevalence of CMV among general population could easily result in transmission.

In most of the literature, infection due to CMV is determined by seropositivity using ELISA method. We also used ELISA; how­ever confirmation by PCR can document the presence of active disease requiring treatment.

In conclusion, ESRD patients undergoing HD should be screened for CMV and a long term outcome studies can help us to identify the risk associated or need for treatment in this popu­lation.


   Acknowledgement Top


The authors would like to thank Urmia Uni­versity of Medical sciences for the grants pro­vided for our study.[Table 1]

 
   References Top

1.Landolfo S, Gariglo M, Gribaudo G, Lembo D. The human cytomegalovirus. Pharmacol Ther 1998;98:69-297 Ref Type: Generic.  Back to cited text no. 1      
2.Boeckh M, Ljungman P. Cytomegalovirus in­fection after bone marrow transplantation. In: Bowden R, Paya C, Ljungman P, eds. Transplant infections. Philadelphia, PA: Lippincott-Raven; 1998. p. 215-27.  Back to cited text no. 2      
3.Lautenschlager I. Cytomegalovirus and solid organ transplantation:as update. Curr Opin Organ Transplant 2003;8:269-75.  Back to cited text no. 3      
4.Stratton KR, Durch KS, Lawrence RS. Vaccines for the 21st century: A tool for decision ma­king. Washington, D.C.: Institute of Medicine; 2000.  Back to cited text no. 4      
5.Dobbins JG, Stewart JA, Demmler GJ, et al. Surveillance of congenital cytomegalovirus disease, 1990-1991. MMWR Morb Mortal Wkly Rep 1992;41(SS-2):35-9.  Back to cited text no. 5      
6.Fowler K, Stagno S, Pass R, Britt W, Boll T, Alford C. The outcome of congenital cyto­megalovirus infection in relation to maternal antibody status. N Engl J Med 1992;326:663-7.  Back to cited text no. 6      
7.Fowler KB, Stagno S, Pass RF. Maternal Immunity and prevention of congenital cyto­megalovirus infection. JAMA 2003;289:1008-11.  Back to cited text no. 7  [PUBMED]    
8.Valizadeh S. CMV infection among renal transplant recipients. Koomeh, Sci J Semnan Univ Med Sci 1999;1(1):9-15.  Back to cited text no. 8      
9.Trakulic M, Jovanovich D, Ostojic G, et al. Cyto­megalovirus infection with kidney diseases. Vajosanit Pregl 2000;57(5):63-7.  Back to cited text no. 9      
10.Hardiman A, Butter KC, Roe CJ, et al. Cyto­megalovirus infection in dialysis patients. Clin Nephrol 1985;23(1):12-7.  Back to cited text no. 10      
11.Ikram H. Cytomegalovirus infections in hemo dialysis centers. Clin Nephrol 1981;15(1):1-4  Back to cited text no. 11      
12.Hardiman AE, Butter KC, Roe CJ, et al. Cyto­megalovirus infection in dialysis patients. Clin Nephrol 1985;23(1):12-7.  Back to cited text no. 12      
13.Sexton DJ, Smith EW, Gutman RA, Helms MJ, Lang DJ. Cytomegalovirus infection and chronic hemodialysis. Clin Nephrol 1979;11 (1):3-6.  Back to cited text no. 13      
14.Abbas MM, Zaki M, Afify NA. Prevalence of antibody to toxoplasma gondii and cytomega­lovirus antibodies in patients with chronic re­nal failure. J Egypt Soc Parasitol 1996;26(3): 671-6.  Back to cited text no. 14      
15.Rubin RH. Infection in the renal transplant patient. In: Rubin RH, Young LS, (eds): Clini­cal approach to infection in compromised Host. New York: Plenum; 2002. p. 553-605.  Back to cited text no. 15      
16.Spisni C, Stingone A, Di Vito R, et al. Serum epidemiological trial on the prevalence of theanti-cytomegalovirus antibodies in patients under substitutive treatment with hemodialysis and CAPD. Nephron 1992;61(3):373-4.  Back to cited text no. 16      
17.Aminzadeh Z, Yaghmaei F, Gachkar L. Pre­valence of cytomegalovirus infection in hemo­dialysis patients in Labbafinejad Hospital in 2002-2003. Khoon (Blood) 2005;3(2):31-5.  Back to cited text no. 17      

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Correspondence Address:
Zakieh Rostamzadeh Khameneh
Department of Microbiology, School of Paramedicine, Urmia University of Medical Sciences, Urmia, West-Azerbaijan
Iran
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PMID: 20228534

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This article has been cited by
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    Abstract
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