Saudi Journal of Kidney Diseases and Transplantation

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

Correspondence Address:
O Taziki
Department of Nephrology, Imam Khomeini Hospital, Mazandaran University, Sari
Iran

Abstract

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


Full Text

 Introduction



HCV transmission via blood transfusion in HD patients was in the greatest rate in the early 1990s. [1] 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. [1]

Prevalence of HCV infection ranged from 8 to 10 % in 2000 [2],[3] 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. [4] Similar fin­dings were reported from Europe [5] and Asia. [6] 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 [5] forcing recommendation of isolation of HCV+ patients in separate units. [6],[7]

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.

 Methods



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.

 Statistical Analysis



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.

 Results



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.

 Discussion



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. [7] 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. [5],[6],[8]

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 [9],[10] 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. [11]

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. [12] However, others had simi­lar findings to our mortality rates. [7]

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.

References

1Tokars JI, Frank M, Alter MJ, Arduino MJ. National survielance of dialysis-associated diseases in the United States, 2000. Semin Dial 2002;15(3):162-71.
2Petrosillo N, Gilli P, Serraino D, et al. Pre­valence of infected patients and under­staffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001;37(5):1004-10.
3Saab S, Brezina M, Gitnick G, Martin P, Yee HF Jr. Hepatitis C screening strategies in hemodialysis patients. Am J Kidney Dis 2001;38(1):91-7.
4Mendez-Sanchez N, Motola-Kuba D, Chavez­Tapia NC, Bahena J, Correa-Rotter R, Uribe M. Prevalence of hepatitis C virus infection among HD patients at a tertiary- care hospital in Mexico city, Mexico. J Clin Microbiol 2004;42(9):4321-2.
5Almroth G, Ekermo B, Mansson AS, Svensson G, Widell A. Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients: A long term follow up (1989-Jan 1997). J Intern Med 2002;251(2):119-28.
6Yang CS, Chang HH, Chou CC, Peng SJ. Isolation effectively prevents the transmi­ssion of hepatitis C Virus in the HD Unit. J Formos Med Assoc 2003;102(2):79-85.
7Espinosa M, Martn-Malo A, Ojeda R, et al. Marked reduction in the prevalence of hepatitis C virus infection in HD patients: causes and consequences. Am J Kidney Dis 2004;43(4): 685-9.
8Silva LK, Silva MB, Rodart IF, et al. Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of HD patients in Salvador, North-eastern Brazil, Brazil. J Med Biol Res 2006;39(5):595-602.
9Ansar MM, Kooloobandi A. Prevalence of hepatitis C virus infection in thalassemia and hemodialysis patients in North Iran, Rasht. J Viral Hepat. 2002;9:390-2.
10Ebrahim-Poor S, Yaghoobi M, Gharamaleki V, Khoshavar H, Sakhinia E, Madadi A. Seroepidemiological studies of hepatitis B and C in hemophilics in north-western Iran. Irn J Med Sci. 1997; 22: 126.
11Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med 2001;345(1):41-51.
12tehman-Breen CO, Emerson S, Gretch D, Johnson RJ. Risk of death among chronic dialysis patients infected with hepatitis C virus. Am J Kidney Dis 1998;32(4):629-34.