Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM ASIA-AFRICA
Year
: 2012  |  Volume : 23  |  Issue : 3  |  Page : 609--613

Prevalence and risk factors of hepatitis B infection among hemodialysis patients in Tabriz: A multicenter report


Jalal Etemadi1, Mohammad Hossein Somi2, Mohammad Reza Ardalan1, Seyed Sadradin Rasi Hashemi1, Gilda Ghazi Soltani3, Mohammadali Mohajel Shoja4,  
1 Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran
2 Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
4 Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Correspondence Address:
Jalal Etemadi
Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz
Iran

Abstract

Hepatitis B virus (HBV) infection is an important issue in hemodialysis. Risk factors and local prevalence varies between different regions. The current study was undertaken to determine the prevalence of HBV infection and its associated risk factors among hemodialysis patients from five hemodialysis centers in Tabriz, a Northwestern Iranian city. Hepatitis B serologic markers were evaluated in chronic hemodialysis patients. Patients (n = 412) were divided into two groups: Group 1 - patients with positive hepatitis B surface antigen (HBsAg) and Group 2 - patients with negative HBsAg. The median age was 54.9 years (range, 13-90 years). Thirteen patients (3.2%) were found to be positive for HBsAg. Among the studied factors, the history of war injury was significantly associated with the risk of HBV infection (P = 0.023). In conclusion, our study shows that the risk of HBV infection among Tabrizian hemodialysis patients is a factor of dialysis-independent parameters.



How to cite this article:
Etemadi J, Somi MH, Ardalan MR, Hashemi SR, Soltani GG, Shoja MM. Prevalence and risk factors of hepatitis B infection among hemodialysis patients in Tabriz: A multicenter report.Saudi J Kidney Dis Transpl 2012;23:609-613


How to cite this URL:
Etemadi J, Somi MH, Ardalan MR, Hashemi SR, Soltani GG, Shoja MM. Prevalence and risk factors of hepatitis B infection among hemodialysis patients in Tabriz: A multicenter report. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Jul 12 ];23:609-613
Available from: http://www.sjkdt.org/text.asp?2012/23/3/609/95857


Full Text

 Introduction



Hepatitis B virus (HBV) infection is a major problem in hemodialysis patients, [1],[2] but the prevalence varies between countries and bet­ween dialysis units within one country. [2] Pre­vious studies have shown that factors such as number of blood transfusion, [2] dialysis duration more than two years, [3],[4] gender, blood transfusion before 1993, [5] age, history of renal transplantation, transient hemodialysis and nationality [6] were linked with the rate of HBV in­fection among hemodialysis patients.

As distribution of the above-mentioned risk factors varies between different regions, it is important to determine the local prevalence and risk factors associated with HBV infection among hemodialysis patients in a given region. This information may be of particular impor­tance in the local preventive planning.

Our study aimed to determine the prevalence of HBV infection and its associated risk fac­tors among hemodialysis patients from five hemodialysis centers.

 Patients and Methods



In a cross-sectional study, hepatitis B serologic markers including hepatitis B surface antigen (HBsAg), antibody to hepatitis B sur­face antigen (anti-HBs) and antibody to hepa­titis B core antigen (anti-HBc IgG antibody) were evaluated in chronic hemodialysis patients from five dialysis units (Madani, Twenty-Nine Bahman, Artesh, Amir al-Momenin and Kodakan hospitals) in Tabriz, a Northwestern Iranian city. Patients older than 12 years who were on hemodialysis for more than 90 days were included. The patients were divided into two groups: Group 1 - patients with positive HBsAg (n = 13) and Group 2 - patients with negative HBsAg (n = 399).

The patients were routinely dialyzed with polysulfone hollow-fiber dialyzers two or three times each week in 4-h sessions using acetate or bicarbonate containing dialysate; dialyzers were not reused. According to ma­nufacturers' instruction, hemodialysis machines were bleached and rinsed between dialysis sessions. HBsAg-positive patients were dialyzed in a separate, isolated room. Per routine plan, serum samples were collected every three to six months from our patients and tested for HBsAg, anti-HBs, anti-HBc and anti-hepatitis C virus. Isolated anti-HBc-positive patients tested for qualitative HBV DNA, and if positive it would be tested for quantita­tive HBV DNA by polymerase chain reaction. The following information was collected: age, sex, marital status, family history of HBV infection, history of previous transfusion, number of blood transfusion, duration of dia­lysis, intravenous illicit drug use, tattooing history, history of previous surgery, history of war injury, previous suspicious sexual contact, history of renal transplantation, etiology of renal failure, history of diabetes mellitus, his­tory of vaccination against HBV, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, prothrombin time, albumin and total and direct bilirubin.

 Statistical Analysis



Data are presented as means ± SD or percen­tages. Statistical analysis was performed using SPSS version 13 using Fisher's exact test and Man-Whitney U test. P-values less than 0.05 were considered as statistically significant.

 Results



A total of 412 patients (264 men and 148 women) from five hemodialysis centers were included in the study. The characteristics of patients are shown in [Table 1] and [Table 2].{Table 1}{Table 2}

Thirteen (3.2%) patients were found to be positive for HBsAg [Table 3]. The median age was 54.9 years (range, 13-90 years). The pri­mary causes of ESRD were diabetic nephropathy in 115 (28.1%) patients, hypertension in 140 (34.2%), glomerulonephritis in 15 (3.7%), tubulointerstitial nephritis in 10 (2.4%), polycystic kidney disease in 33 (8.1%), hereditary nephritis in five (1.2%), urologic disorders in 21 (5.1%) and unknown etiology in 70 (17.1%). Fourteen (4.6%) patients had isolated anti-HBc antibody; HBV DNA was not detec­ted in these patients.{Table 3}

The history of war injury was significantly associated with the risk of HBV infection among the patients (P = 0.023). No significant difference was detected between HBsAg-positive and HBsAg-negative patients in terms of age, sex, marital status, positive family his­tory of HBV infection, history of previous transfusion, number of blood transfusion, du­ration of dialysis, intravenous illicit drug use, history of tattooing, previous surgery, previous suspicious sexual contact, renal transplanta­tion, etiology of renal failure, diabetes mellitus and hepatitis B vaccination. There was a significant difference in the median levels of albumin between the two subgroups (4.7 ver­sus 4.2 g/L, P = 0.036). The HBV seroconversion rate after vaccination was 40.5%. There were no new cases of seroconversion to HBsAg positivity during hemodialysis among our patients.

 Discussion



It is estimated that there are more than 350 million HBV carriers in the world. [7] The preva­lence of HBV carriers in the general popu­lation varies from less than 2% in low-preva­lence areas to 8% in high-prevalence areas. [8] The prevalence of positive HBsAg in Iran is 3.5%. [9] The lack of significant association bet­ween the studied risk factors and HBV infec­tion in our study except the risk of war injury (dialysis-independent risk factor) and absence of new seroconversion case to HBsAg positivity during hemodialysis as well as concor­dance of observed prevalence of HBV infec­tion with the general population led us to propose that the risk of HBV infection among Tabrizian hemodialysis patients is a factor of dialysis-independent parameters.

In the present study, 14 (4.6%) of the patients were found to have isolated anti-HBc anti­body. Yildirim et al recently investigated the rate of HBV-DNA positivity among 45 patients with only anti-HBc-positive tests and found that 24.4% of them had positive HBV-DNA titers. [10] In another study, over 395 high-risk patients, including 289 on HD and 106 HIV-infected, HBV-DNA was detected in 12 of 40 patients who had isolated anti-HBc antibody. [11] Even though HBV DNA was not detected among Tabrizian hemodialysis pa­tients who had isolated anti-HBc antibody, this may not diminish the significance of anti-HBc as the sole marker of HBV infection in hemodialysis patients. It may be prudent to employ more sensitive assays in isolated anti-HBc antibody-positive hemodialysis patients for re­ducing the potential risk of HBV transmission.

The response rate to HBV vaccine in hemodialysis patients ranges from 50% to 80% in the different studies. [12],[13],[14] The response rate after vaccination in the present study was 40.5%. Factors such as older age at the time of vaccination, [15] poor nutrition, [16] infection with hepatitis C virus, [17] presence of certain HLA haplotypes, [18],[19] diabetes mellitus, lower urea clearance by dialysis (KT/V) and lower ratio of lean to total body mass [20] are associated with a low vaccine response rate among hemodialysis patients. The lower response rate in our study may mandate need for use of different vaccination protocol or adjuvant therapy.

There was significant difference in the me­dian levels of albumin between the two sub­groups (4.7 versus 4.2 g/L, P = 0.036) in our study, but this finding may not have a clinical significance.

In conclusion, our study shows that the risk of HBV infection among Tabrizian hemodialysis patients is a factor of dialysis-indepen­dent parameters.

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