RENAL DATA FROM THE ARAB WORLD
Year : 2007 | Volume
: 18 | Issue : 1 | Page : 101--106
Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report
HH El-Amin1, EM Osman1, MO Mekki2, MB Abdelraheem1, MO Ismail1, MEA Yousif1, AM Abass2, HS El-haj1, HK Ammar3,
1 Dr Salma Center for Dialysis and Kidney Transplantation, University of Khartoum, Sudan
2 Khartoum Teaching Hospital, Federal Ministry of Health, Khartoum, Sudan
3 Ahfad University for Women and Epidemiological Laboratory, Khartoum, Sudan
M O Mekki
Khartoum Teaching Hospital, Federal Ministry of Health, Khartoum
Prevalence of HCV seropositivity among the hemodialysis population in Sudan is estimated to be around 34%. We undertook a cross sectional study in two major HD centers in Khartoum, Sudan for the prevalence of HCV seropositivity among the hemodialysis patients, during January to -March 2005. Testing for HCV antibodies was performed using 3 rd generation enzyme linked immunoadsorption assay (ELISA). A total of 236 patients were included in the study: 218 adults and 18 children. The mean age was 43.6 ± 15.6 years, and the majority was males: 71.6%. The cause of renal failure was unknown in 168 patients (71.2%). The mean HD duration was 36.6 ± 35.1 months. Prevalence of HCV seropositivity was 23.7%. Among 170 patients who were previously HCV seronegative, 30 (17.1%) seroconverted to positive in one year (estimated incidence: 63 new cases per year). HCV seropositivity was associated with longer duration of dialysis (p < 0.00001), previous surgery (p= 0.026), age of over 30 and years (p = 0.008), and dialysis in multiple centers (p= 0.005). We conclude that although HCV seropositivity in our study was lower than previously reported, it was still high among HD patients in Sudan. Nosocomial transmission of HCV among hemodialysis patients is a contributing factor.
|How to cite this article:|
El-Amin H H, Osman E M, Mekki M O, Abdelraheem M B, Ismail M O, Yousif M, Abass A M, El-haj H S, Ammar H K. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report.Saudi J Kidney Dis Transpl 2007;18:101-106
|How to cite this URL:|
El-Amin H H, Osman E M, Mekki M O, Abdelraheem M B, Ismail M O, Yousif M, Abass A M, El-haj H S, Ammar H K. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2020 Dec 2 ];18:101-106
Available from: https://www.sjkdt.org/text.asp?2007/18/1/101/31856
Hepatitis C virus (HCV) infection is a major health problem among hemodialysis (HD) patients in developing countries.  This could be due to the non-adherence to the strict universal infection control measures and the unavailability of vaccines to prevent hepatitis C infection. Moreover, the increased facilities and advanced hemodialysis techniques have prolonged patients' survival which increased their risk of acquiring HCV. 
In a survey done in Khartoum in the year 2001, HCV antibodies was detected in 0.4 % of blood donors and in 5.5% of multiply transfused patients.  Other reports among the general population from Western and Southern Sudan showed a prevalence of 2-3 %. ,
In patients on maintenance HD, viral hepatitis remains a major health problem not only for patients but also for dialysis staff . The onset and clinical diagnosis of HCV infection is often insidious and the majority of cases are detected incidentally during blood donation or routine HD screening.  Previous reports of the prevalence of HCV seropositivity from Sudan was 34% in 1994.
We aim in this study to evaluate the prevalence of HCV in the two largest HD centers in Khartoum, Sudan after more than a decade of improvement of the laboratory assays and expansion of the HD facilities in Sudan.
Patients and Methods
A cross sectional survey of patients on maintenance HD at Dr Salma's (SDKTC) and Khartoum (KDC) HD centers was conducted in the period from January to - Mar 2005.
A designed questionnaire was used for data collection; the data included: age, sex, cause of renal failure, duration of dialysis, previous blood transfusion, number of blood transfusions received and history of dialysis in multiple centers. Shared needles, tattooing, and previous HCV positivity were also recorded.
Antibodies against HCV were tested using 3 rd generation enzyme linked immunoadsorption assay (ELISA) (Intec products, INC. Cx1AMEN). HBsAg was also checked using auszyme monoclonal test.
All patients were on HD for 8-12 hours/ week. Disinfection of the machines was done according to the manufacturers' protocol. Dedicated machines were used for patients who were HCV seropositive in KDC but not in SDKTC, while patients who were hepatitis B virus seropositive were isolated in both centers.
Statistical analysis was done using SPSS program for windows version 10. All values, unless otherwise stated, are expressed as a mean ± SD. Independent 't' test was used to evaluate the association of continuous variables with HCV seropositivity. P-value of Egypt, ,[ 21] Jordon,  Morocco,  Senegal,  Iran,  but similar to reports from Oman,  and Italy. 
However, our HCV prevalence of seropositivity was greater than that reported from Kenya, [ 28] South Africa,  Turkey, USA , and Mexico .In our study, HCV seropositivity was significantly associated with longer duration on dialysis, older age, previous surgery, and dialysis in multiple centers. This concurs with many regional and international reports, as longer duration on HD was shown to be a significant risk factor for HCV seropositivity among hemodialysis patients. ,,,,, , , , , ,,],,,,
Previous surgery was shown to be associated with hepatitis C seropositivity among hemodialysis patients in Italy,  and non dialysis patients in Turkey.  Dialysis in multiple centers was found to be significantly associated with higher HCV seropositivity in Saudi Arabia.
With regards to previous renal transplantation, there was small number of patients in our study who underwent previous transplantation, and so it was difficult to derive conclusions from the results. Previous renal transplantation was shown to be a risk factor for HCV seropositivity in reports from the USA.
HCV seropositivity was noted to be significantly higher among HD patients older than 30 years; This agrees with reports from USA,  and Saudi Arabia.
In our study, neither blood transfusion, nor the number of blood units received, were significantly associated with hepatitis C seropositivity. This agrees with previous report from SDKTC,  and with other regional, ,,,, and international reports. . However blood transfusion was shown to be a risk factor for hepatitis C seropositivity among hemodialysis patients in many other reports. , , , , , Patients' gender was not associated with HCV seropositivity in our studied population. This agrees with reports from Jordan,  and Syria. However male sex was reported to be associated with HCV seropositivity in one report from Saudi Arabia.
Other risk factors for HCV infection were not found to be associated with HCV seropositivity in our studied population, namely tattooing, shared needles and previous jaundice. This concurs with a previous report from Khartoum. 
We conclude that although the prevalence of HCV seropositivity found in our study was less than that reported previously from the same area, it continued to be elevated. Longer dialysis duration, previous surgery, age of 30 and more, and multiple dialysis center, were all associated risk factors. However, blood transfusion was not associated
with HCV seropositivity in our studied population. Nosocomial transmission seems to be an important route for transmission of HCV infection.
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