Saudi Journal of Kidney Diseases and Transplantation

: 2010  |  Volume : 21  |  Issue : 6  |  Page : 1169--1171

Incidence of hepatitis C infection in patients on hemodialysis: A multicenter study of northern part of Iran

Farhad Zamani1, Mitra Ameli1, Sara Razmjou1, Ramin Shakeri2, Afsaneh Amiri1, Rasoul Darvish3,  
1 Gastrointestinal and Liver Disease Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
2 Digestive Diseases Research Centre, Shariaty Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Azad University of Tonekabon, Gilan, Iran

Correspondence Address:
Farhad Zamani
Firuzgar Hospital, Iran University of Medical Sciences, Tehran


Hepatitis C virus (HCV) is one of the perilous problems in hemodialysis (HD) centers around the world. There are many risk factors regarding HCV infection in HD units. The aim of this study was to evaluate the incidence of HCV infection in HD units and also to assess the potential risk factors in this regard. A total of 334 patients on regular HD were evaluated. All the patients were seronegative for anti-HCV antibody in the beginning of this study. They were followed every 6 months with repetition of tests. Positive samples were tested by polymerase chain reaction (PCR) for confirmation. The prevalence of HCV infection was about 20%. No sig­nificant relationship between numbers of blood transfusion, age and sex was obtained. A positive correlation between HCV infection and duration of HD for more than 5 years was significant. In conclusion, our study found the prevalence of HCV infection to be significantly higher than its incidence in the general population.

How to cite this article:
Zamani F, Ameli M, Razmjou S, Shakeri R, Amiri A, Darvish R. Incidence of hepatitis C infection in patients on hemodialysis: A multicenter study of northern part of Iran.Saudi J Kidney Dis Transpl 2010;21:1169-1171

How to cite this URL:
Zamani F, Ameli M, Razmjou S, Shakeri R, Amiri A, Darvish R. Incidence of hepatitis C infection in patients on hemodialysis: A multicenter study of northern part of Iran. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2021 Oct 21 ];21:1169-1171
Available from:

Full Text


Chronic infection with hepatitis C virus (HCV) is an important global health problem. HCV infection is widespread and 3% of the world population is reported to be persistently infec­ted. [1] The prevalence of HCV infection in pa­tients undergoing dialysis is greater than that in the general population, suggesting that pa­tients on dialysis may be at higher risk of acqui­ring HCV infection. This is predominantly be­cause these patients are more exposed to risk factors for acquisition of this infection and also because they are monitored monthly by laboratory examinations that permit an early diagnosis of the infection. It is endemic in he­modialysis (HD) units around the world, pre­dominantly in Mediterranean and the develo­ping countries of the Middle East and Far East. [2],[3] The prevalence of anti-HCV seroposi­tivity in patients undergoing regular dialysis in developed countries ranges between 7% and 40%. [4] Its importance is also recognized as it is the most frequent cause for liver transplanta­tion in the US and Europe. [5],[6]

The aim of the present study was to deter­mine the incidence of HCV in 334 HD patients in the nephrology department at four centers in the northern part of Iran and also to assess the possible risk factors leading to the transmi­ssion of HCV in HD patients.

 Methods and Materials

We studied 334 patients on regular hemodia­lysis treatment at the nephrology department of four centers including Amol, Tonekabon, Rasht, Ramsar in the north of Iran during 1998-2005.

The patients were informed about the study and they all gave written informed consent. All the patients were seronegative for anti-HCV antibody before their first admission. Serum samples were tested for anti-HCV antibody by ELISA-II. The patients were followed and every six months anti-HCV antibody test was repea­ted. Those with a positive result underwent HCV RNA test determined by polymerase chain re­action (PCR). A positive PCR test was consi­dered as HCV infected. Questionnaires were filled out for each patient. Information was ob­tained regarding the transfusion history, num­ber of blood transfusion, duration of dialysis, results of serological testing for HCV, and whe­ther the patient was an intravenous drug abuser or not.

 Statistical Analysis

Statistical analysis was performed using SPSS version 11, chi-square, mann-whitny and independent t-test. P values less than 0.05 were considered significant. The quantitative varia­bles are expressed as mean ± standard devia­tion (SD).


During this study, 334 patients (169 women and 165 men) were treated with HD. Mean age of the patients was 50.9 ± 14.5 years. Also, 20% of the patients seroconverted during the observation period. Mean duration of dialysis among anti-HCV positive patients was 7.2 ± 2.2 years which was significantly higher than that of anti-HCV negative patients (P value 0.005). Data are summarized in [Table 1].{Table 1}

There was a positive correlation between po­sitive anti-HCV and the duration of dialysis. More than five years treatment with dialysis was a risk factor of HCV infection (OR = 5.5).

Mean units of blood transfusion in anti-HCV positive group and anti-HCV negative group were 6.05 and 5.67, respectively (P > 0.05).

No significant relationship between age and sex with positive anti-HCV was observed in this study. No patient had a history of intravenous drug abuse.


HCV infection has a detrimental effect on sur­vival in dialysis patients with end-stage renal disease (ESRD). Studies have also shown a lower survival after kidney transplantation of HCV-infected patients than that of anti-HCV­negative patients. [7] Since preventive measures have reduced the risk of transmission of he­patitis B virus, HCV has become the leading cause of dialysis-associated hepatitis. Although the risk of acquiring HCV has decreased since the introduction of erythropoietin, the preva­lence of HCV infection has remained high among dialysis patients. [8] As stated earlier, anti­HCV seropositivity in patients undergoing re­gular dialysis in developed countries ranges between 7% and 40%, whereas in the general population it has been reported to be between 0.3% and 1.6%. [8],[4] In our study of the HD pa­tients in the northern part of Iran, the incidence of HCV was obtained as 20%. The incidence of HCV among the general population of Iran is not obvious but considering it as in other countries, it is 10 times more among patients on HD. So, this study was conducted to eva­luate the risk factors associated with HCV transmission.

Total duration of HD is a known risk factor of HCV transmission. The interval from the beginning of the dialysis was significantly longer among anti-HCV positive patients than among anti-HCV negative patients. [9] Similarly, we found a positive correlation between po­sitive anti-HCV and the duration of dialysis.

Even though repeated blood transfusions have been reported to be a risk factor for HCV trans­mission, data on correlation between anti-HCV positivity and number of blood transfusions are inconclusive. [2] Blood transfusions had been the major source of HCV infection for many years, but with sensitive HCV screening tests for blood donors (ELISA HCV), the risk of post transfusion HCV infection has been found to be less than 1/100,000 blood units. [10] As nosocomial transmission has been reported to be the foremost route of HCV infection in HD units worldwide, [2] isolation of anti-HCV posi­tive patient sounds to be the most efficient way of reducing HCV transmission.

In conclusion, HCV is a frequent occurrence in HD patients and isolation policy of HCV­antibody positive patients can play a signifi­cant role in limiting HCV transmission in HD units.


1Burra P, Masier A, Morisco F, et al. HCV infection in haemodialysed patients: A role for serum IL-10 and TGF-beta1 in liver damage? Dig Liver Dis 2008;40(10):827-33.
2Saxena AK, Panhotra BR, Sundaram DS, et al. Impact of dedicated space, dialysis equipment and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. Am J Infect Control 2003;31(1): 26-33.
3Lemos LB, Perez RM, Matos CA, Silva IS, Silva AE, Ferraz ML. Clinical and laboratory characteristics of acute hepatitis C in patients with end-stage renal disease on hemodialysis. J Clin Gastroenterol 2008;42(2):208-11.
4Martin P, Fabrizi F. Hepatitis C virus and kidney disease. J Hepatol 2008;49(4):613-24.
5Khuroo MS, Khuroo MS, Dahab ST. Meta­analysis: A randomized trial of peginterferon plus ribavirin for the initial treatment of chro­nic hepatitis C genotype 4. Aliment Pharmacol Ther 2004;20(9):931-8.
6Colombo M, Kuo G, Choo QL, et al. Pre­valence of antibodies to hepatitis C virus in Italian patients with hepatocellular carcinoma. Lancet 1989;2(8670):1006-8.
7Rocha CM, Perez RM, Narciso JL, et al. Interferon-alpha therapy within the first year after acute hepatitis C infection in hemodia­lysis patients: Efficacy and tolerance. Eur J Gastroenterol Hepatol 2007;19(2):119-23.
8Weinstein T, Tur-Kaspa R, Chagnac A, et al. Hepatitis C infection in dialysis patients in Israel. Isr Med Assoc J 2001;3(3):174-7.
9Pereira BJ. Hepatitis C virus infection in dialysis: a continuing problem. Artif Organs. 1999;23(1):51-60.
10Knudsen F, Wantzin P, Rasmussen K. Hepa­titis C in dialysis patients: A relationship to blood transfusion, dialysis and liver disease. Kidney Int 1993;43:1353-6.