RENAL DATA FROM THE ARAB WORLD
Year : 2001 | Volume
: 12 | Issue : 4 | Page : 562--565
Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia
Anil K Saxena1, BR Panhotra2, Mohamed Naguib1, Mohammed Nabil Aboras1, DS Sundaram1, CK Venkateshappa1, Wahid Uzzaman Khan1,
1 Post-Graduate Department of Medicine, King Fahad Hospital, Hofuf, Al-Hasa, Saudi Arabia
2 Department of Microbiology, King Fahad Hospital, Hofuf, Al-Hasa, Saudi Arabia
Anil K Saxena
Hemodialysis Unit, King Fahad Hospital, Hofuf, Al-Hasa 31982
The prevalence of anti-HCV antibodies among hemodialysis (HD) patients was studied at King Fahad Hospital, Hofuf, Saudi Arabia. The records of 189 patients undergoing HD were reviewed. The overall prevalence of anti-HCV antibodies was 43.9%. Anti-HCV antibody prevalence was more common among female patients. There was no correlation between repeated blood transfusions and anti-HCV positivity as 4.8% of the patients who did not receive any blood transfusion during HD were positive for anti-HCV antibodies. A positive correlation was observed between the duration on dialysis and antiHCV antibodies. An annual serocoversion rate of 6.8% was observed in this study.
|How to cite this article:|
Saxena AK, Panhotra B R, Naguib M, Aboras MN, Sundaram D S, Venkateshappa C K, Khan WU. Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia.Saudi J Kidney Dis Transpl 2001;12:562-565
|How to cite this URL:|
Saxena AK, Panhotra B R, Naguib M, Aboras MN, Sundaram D S, Venkateshappa C K, Khan WU. Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2001 [cited 2019 Sep 21 ];12:562-565
Available from: http://www.sjkdt.org/text.asp?2001/12/4/562/33547
Hepatitis C virus (HCV) infection has become a major cause of mortality and morbidity in end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) and is particularly highly prevalent in developing countries.  In Saudi Arabia, a positivity rate of HCV ranging between 14.5 and 94.7% has been reported.  HCV infection is of great clinical importance since: (a) it is commonly associated with chronic liver disease and cirrhosis,  (b) it can lead to the development of hepatocellular carcinoma,  (c) there is an increased risk of developing chronic liver disease in renal allograft recipients who are anti-HCV positive and,  (d) till date, no vaccine has been developed for HCV.
The factors that play a role in maintaining high prevalence of anti-HCV positivity among HD patients are not well understood. The present study was carried out to find out the prevalence of anti-HCV antibodies among HD patients, its correlation with blood transfusion and duration on HD.
Patients and Methods
The records of 189 patients enrolled for HD at the King Fahad Hospital, Hofuf, were reviewed. These patients were dialyzed for 34 hours thrice-weekly using cuprophane membrane dialyzers. Universal precautions for infection control are routinely practiced in our HD center. Disinfection of HD machines was performed with hot water and chemical disinfectants as per the recommendations of the machine manufacturers.  A strict protocol of careful chemical disinfection using citrosteril, run at 85 0 C for 35 minutes after each dialysis session was adopted before using the machine for the next patient. Hot water, at 80-90 0 C, was run at high flow rate after full chemical disinfection for 60 minutes. This procedure was performed at the end of the day on every machine in preparation for the next day's work.
The mean age of the study patients was 47.5 years (range 15-85 years). There were 91 males and 98 females. All the patients had ESRD and had been on HD for a mean duration of 73.5 months (range 3-144 months).
Blood samples were collected from these patients and serum was stored at -20 0 C till analyzed for anti-HCV antibodies by ELISA using Murex version III kits (Murex diagnostics, France). All the anti-HCV positive samples were confirmed by immunoblot assay, CHIRON-RIBA-HCV 3.0 (Ortho clinical diagnostics, USA). The hepatitis B surface antigen (HbsAg) status of all these patients was studied by ELISA method using Abbott diagnostic kits.
Out of the 189 patients studied, 83 (43.9%) were found to be anti-HCV positive of whom 35 (42.2%) were males and 48 (57.8%) females. The maximum prevalence was observed among female patients in the age-group of 31-60 years [Table 1].
There was no correlation between blood transfusion and anti-HCV antibody positivity. Of the 83 anti-HCV positive patients, 79 (95.2%) had received multiple blood transfusions during the period they were on HD. However, four patients (4.8%) who had never received blood transfusions were also positive for anti-HCV. Also, of the 106 antiHCV negative patients, 92 had received a mean of 6 + 2.2SD units of blood transfusion.
There was a positive correlation between HCV positivity and the duration on HD. Out of the 83 patients positive for anti-HCV antibodies, 62 (74.7%) were on HD for more than five years [Table 2]. Only 14 (7.4%) out of 189 patients were positive for HbsAg. Five (6.0%) of the anti-HCV positive patients were also positive for HbsAg.
The anti-HCV antibody prevalence rate of 43.9% in our patients is comparable to the already reported positivity rate of 43.2% from the eastern province.  However, it is much lower than that reported from other centers in the Kingdom. Higher anti-HCV positivity (72.3%) has been reported from the western province of Saudi Arabia. , In another multi-center study, positivity of 68% has been reported.  Strict adherence to universal precautions as recommended by CDC and meticulous regular disinfection of HD machines could possibly be reasons of relatively low anti-HCV positivity at our center.
Repeated blood transfusions is a risk factor for HCV transmission. However, data on correlation between anti-HCV positivity and number of blood transfusions is inconclusive. In some studies, a positive correlation with blood transfusion has been reported , while others have refuted this possibility. , Our results are in concordance with the latter group as four (4.8%) of our patients, who had not received any blood transfusion were found to be positive for anti-HCV antibodies. All the blood donors in this hospital are screened for HbsAg and HCV antibodies. HbsAg positivity among blood donors in this region is 2.2% and anti-HCV antibody positivity is 1.5%. This indicates that the overall anti-HCV positivity in the Al-Hasa population is low (B.R. Panhotra-personal communication). This is an indicator of an alternative mode of transmission. An increased prevalence of anti-HCV positivity among patients on HD for longer periods of time has been reported. , We also observed a strong association between the duration on HD and anti-HCV positivity.
Dialysis treatment could be a specific independent risk factor for HCV transmission as cross infection could be responsible for high prevalence of anti-HCV positivity in HD patients. We observed an average annual seroconversion rate of 6.8% at our center, which is consistent with the reported annual seroconversion rate of 7-9% among HD patients of Saudi Arabia. 
The positive correlation of anti-HCV positivity with duration on HD coupled with 4.8% positivity among patients who had never been transfused, indicate strong possibility of nosocomial transmission of HCV. Similar observations have been reported from other HD centers. ,, Hence, the importance of strict adherence to universal infection control precautions should be emphasized in all the HD centers.
The authors would like to thank Mr. Tushar Saxena and Leny Patricio, Head Nurse, Hemodialysis Unit for their secretarial assistance.
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