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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2001  |  Volume : 12  |  Issue : 4  |  Page : 562-565
Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia

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

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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.

Keywords: Hepatitis C virus, Hemodialysis, Al-Hasa, Saudi Arabia.

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;12:562-5

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 2021 Aug 5];12:562-5. Available from: https://www.sjkdt.org/text.asp?2001/12/4/562/33547

   Introduction Top

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. [1] In Saudi Arabia, a positivity rate of HCV ranging between 14.5 and 94.7% has been reported. [2] HCV infection is of great clinical importance since: (a) it is commonly associated with chronic liver disease and cirrhosis, [3] (b) it can lead to the development of hepatocellular carcinoma, [4] (c) there is an increased risk of developing chronic liver disease in renal allograft recipients who are anti-HCV positive and, [5] (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 Top

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. [6] 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.

   Results Top

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.

   Discussion Top

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. [7] 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. [8],[9] In another multi-center study, positivity of 68% has been reported. [10] 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 [11],[12] while others have refuted this possibility. [13],[14] 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. [15],[16] 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. [17]

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. [18],[19],[20] Hence, the importance of strict adherence to universal infection control precautions should be emphasized in all the HD centers.

   Acknowledgement Top

The authors would like to thank Mr. Tushar Saxena and Leny Patricio, Head Nurse, Hemodialysis Unit for their secretarial assistance.

   References Top

1.Alter HJ. Transmission pattern in hepatitis C virus infection. In: Nishioka K, et al. (eds). Viral hepatitis and liver disease. Springer Verlag 1993;445-9.  Back to cited text no. 1    
2.Huraib S, Al-Rasheed R, Aldrees A, et al. High prevalence and risk factors for hepatitis C in Saudi Arabia: a need for new strategies in dialysis practice (Abst.). Saudi Kidney Dis Transplant Bull 1993;4:S73.  Back to cited text no. 2    
3.Cuthbert JA. Hepatitis C. Am J Med Sci 1990;299:346-55.  Back to cited text no. 3  [PUBMED]  
4.Kew MC, Houghton M, Choo QL, Kuo G. Hepatitis C virus antibodies in southern African blacks with hepatocellular carci­noma. Lancet 1990;335:873-4.  Back to cited text no. 4  [PUBMED]  
5.Wright TL. Hepatitis C virus infection and organ transplantation. Prog Liver Dis 1993; 11:215-30.  Back to cited text no. 5  [PUBMED]  
6.Technical Manual Hemodialysis Machine. A 2008 C Fresenius 1989,1-16.  Back to cited text no. 6    
7.Al-Muhana FA. Hepatitis C virus infection among hemodialysis patients in the Eastern region of Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6:125-7.  Back to cited text no. 7    
8.Shaheen FAM, Huraib SO, Al Rasheed R, et al. Prevalence of hepatitis C antibodies among hemodialysis patients in Western province of Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6:136-9.  Back to cited text no. 8    
9.Saad SS, Mohamed AA, Tarif H, et al. The prevalence of hepatitis C virus antibodies among hemodialysis patients in Jeddah area, Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6:128-31.  Back to cited text no. 9    
10.Huraib S, Al-Rasheed R, Aldress A, et al. High prevalence and risk factors for hepatitis C in Saudi Arabia. Saudi Kidney Dis Transplant Bull 1993;4:73.  Back to cited text no. 10    
11.Dentico P, Boungiorno R, Volpe A, et al. Prevalence and incidence of hepatitis C virus in hemodialysis patients: study of risk factors. Clin Nephrol 1992;38:49-52.  Back to cited text no. 11    
12.Ayoola EA, Huraib S, Arif M, et al. Prevalence and significance of antibodies to hepatitis C virus among Saudi hemo­dialysis patients. J Med Virol 1991;3:155-9.  Back to cited text no. 12    
13.Hardy NM, Sandroni S, Danielson S, Wilsom WJ. Antibody to hepatitis C virus increases with time on hemodialysis. Clin Nephrol 1992;38:44-8.  Back to cited text no. 13    
14.Vitale C, Tricerri A, Marangella M, et al. Epidemiology of hepatitis C virus infection in dialysis units: first-versus second­generation assays. Nephron 1993;64:315-6.  Back to cited text no. 14  [PUBMED]  
15.Oguchi H, Terashima M, Tokunaga S, et al. Prevalence of anti-HCV in patients on long-term hemodialysis. Nippon Jinzo Gakkai Shi 1990;32:313-7.  Back to cited text no. 15  [PUBMED]  
16.Giammaria U, De Meo F, Acetelli S, et al. HCV infection in hemodialyzed patients: incidence and correlation with dialytic age. Nephron 1992;61:335-6.  Back to cited text no. 16    
17.Souqiyyeh MZ, Shaheen FAM, Huraib SO, Al-Khader AA. The annual incidence of serocon-version of antibodies to hepatitis C virus in hemodialysis population in Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6:167-73.  Back to cited text no. 17    
18.Teruel JL, Pascual J, Liano F, Ortuno J. Importance of nosocomial transmission of hepatitis C virus infection in dialysis units. Clin Nephrol 1992;38:232-3.  Back to cited text no. 18    
19.Knudsen F, Wantzin P, Rasmussen K, et al. Hepatitis C in dialysis patients: relationship to blood transfusions, dialysis and liver disease. Kidney Int 1993;43:1353-6.  Back to cited text no. 19  [PUBMED]  
20.Favero MS, After MF, Bland LA. Dialysis associated with infections and their control. In: Hospital infection 1992; 3rd Edition, 375-403.  Back to cited text no. 20    

Correspondence Address:
Anil K Saxena
Hemodialysis Unit, King Fahad Hospital, Hofuf, Al-Hasa 31982
Saudi Arabia
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PMID: 18209404

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