RENAL DATA FROM THE ASIA - AFRICA
Year : 2008 | Volume
: 19 | Issue : 3 | Page : 475--478
Prevalence of Hepatitis C Virus Infection in Hemodialysis Patients
O Taziki, F Espahbodi
Department of Nephrology, Imam Khomeini Hospital, Mazandaran University, Sari, Iran
Department of Nephrology, Imam Khomeini Hospital, Mazandaran University, Sari
The prevalence of hepatitis C virus (HCV) infection in hemodialysis patients (HD) has decreased significantly during the past decade in most HD units. To evaluate the cause(s) of this reduction, we studied the HCV antibodies measurements in 1006 HD patients in the Province of Mazandaran, Iran, from January 2001 to December 2006. In December 2001, the prevalence of antibody to HCV was 18%, whereas by December 2006, it decreased to12%. Causes implicated in the reduction of prevalence of HCV infection in HD patients include a low percentage of new anti-HCV+ patients, a decrease in the conversion rate in HD patients, and more strict infection control measures in the dialysis units.
|How to cite this article:|
Taziki O, Espahbodi F. Prevalence of Hepatitis C Virus Infection in Hemodialysis Patients.Saudi J Kidney Dis Transpl 2008;19:475-478
|How to cite this URL:|
Taziki O, Espahbodi F. Prevalence of Hepatitis C Virus Infection in Hemodialysis Patients. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Jul 7 ];19:475-478
Available from: http://www.sjkdt.org/text.asp?2008/19/3/475/40518
HCV transmission via blood transfusion in HD patients was in the greatest rate in the early 1990s.  However, the prevalence of hepatitis C virus (HCV) infection has decreased significantly in the past decade mainly due to serological monitoring of blood donors and decrease in need for transfusions after the introduction of erythropoietin (Epo) for the treatment of anemia in this population. 
Prevalence of HCV infection ranged from 8 to 10 % in 2000 , according to the national monitoring program for dialysis associated diseases in the United States, and the mean prevalence of 10.4% reported in 1995 decreased to 8.4% in 2000.  Similar findings were reported from Europe  and Asia.  The cause of this tendency to this decrease has not been clearly elucidated.
On the other hand, epidemics of acute HCV infection still occur in some HD centers  forcing recommendation of isolation of HCV+ patients in separate units. ,
The objective of the present study is to determine the prevalence of HCV infection in HD patients in the province of Mazandaran, Iran during the past five year in order to predict its behavior during the coming years.
This is a prospective study evaluate the evolution of the prevalence of HCV infection in all the HD units (2 central hospital and 8 free standing dialysis units) in the Province of Mazandaran, Iran, from 2001-2006.
During the study period, dialysis prescriptions in our HD patients ranged from 3-5 hours sessions, 2-4 times/week and they were individually modified to achieve a target KT/V of 1.2 or greater. All the patients were dialyzed against acetate based bath with disposable dialyzers. Reuse of dialyzers was not practiced in any HD unit in our province. Anti-HCV positive patients were assigned the same dialysis machine each session of dialysis.
The blood screenings for the anti-HCV antibodies were performed at least every third month on all the chronic HD patients. In addition, the test was performed routinely on all the patients at time of entry to the HD maintenance therapy.
We analyzed the annual mortality and transplantation in the HCV- and HCV+ patients for the newly added, old, and transferred patients from other units to our program.
Overall annual mortality was calculated as (dead patients/risk patients) x100. Chi-square test was used to compare qualitative variables. That were expressed as mean ± standard error.
A total of 1006 (52.3% males) patients with mean age of 47.3 ± 12.4 were admitted to the maintenance HD therapy in the Province of Mazandaran; 979 patients were new predialysis patients, whereas 27 patients (2.7%) were patients with failed renal allografts. The causes of end-stage renal disease included 42.1%, diabetes, unknown 40%, 11% glomerulonephritis, and 5% polycystic kidney disease. Overall, 273 (27%) HD patients died, 236 (23%) HD patients received a kidney transplant, And 2 (0.1%) HD patients changed from PD to HD therapy during the study period. Overall annual mortality was 14% and 15% in 2001 and 2006, respectively.
[Table 1] shows that prevalence of antiHCV+ patients was 18% in 2001, which decreased to 12% by 2006. Throughout the follow-up period, new anti-HCV+ patients were admitted to the HD program from the pre-dialysis stage (n=18, 5 %) in addition to patients from the pool of rejected renal allografts (n=15, 3%). One patients permanently lost the antibodies, and only 1 new case converted to anti-HCV+. Anti-HCV+ caused death in 45 (16%) HD patients, and 26 (11%) kidney transplant patients.
The results of this study demonstrate a decline in prevalence of anti HCV+ HD patients during from 18% to 12% over five years compared to 0.4% prevalence in healthy blood donors at 2001 that increased to 0.8% in 2006. The prevalence of 18% in our HD patients was more than the rate of 10.8% reported inform Spain in 2000.  However, as observed in our study, there has been a similar decreasing tendency in the prevalence of anti-HCV+ among the HD patients reported from many HD facilities worldwide. ,,
We believe that there are three main reasons for the decrease in prevalence of anti HCV+ in HD patients. These include a low percentage of new anti-HCV+ patients, a decrease in the conversion rate in HD patients, and more strict infection control measures in the dialysis units.
The prevalence of HCV+ of 3% in the predialysis group in our study is slightly reater than that in blood donors in Iran , and is a reflection of the greater risk of patients with renal insufficiency for acquiring this infection and the pathogenic role of HCV in the development of certain kidney diseases. 
High prevalence of patients with HCV risk infection in HD facilities has been considered a risk factor for transmission of this disease. The HD units in our region with a prevalence greater than 12% include Amol 13%, Sari Hazrat Fatemeh 21%, Qaemshahr 30%. The HD units that started after 2001, had a significantly decreased prevalence.
Throughout the study, the annual mortality rate in anti-HCV-positive patients was not significantly different from that in antiHCV-negative patients. Some studies reported higher mortality rate associated with HCV infection.  However, others had similar findings to our mortality rates. 
In summary, we did not find an obvious cause for decreasing the prevalence of HCV infection in our patients. However, a low percentage of new anti-HCV+ patients, a decrease in the conversion rate in HD patients, and more strict infection control measures in the dialysis units are the most likely contributing factors.
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