Prevalence of hepatitis B and hepatitis C in haemodialysis patients

The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B exposure and antibodies against the hepatitis C virus (anti-HCV) was assessed in 86 haemodialysis patients at the National Kidney and Transplant Institute (NKTI) using the commercial radioimmunoassay and ortho HCV ELISA assay. Of the 86 patients included in the study, 42 were male with a mean age of 44.9 years and a mean duration of dialysis of 2.4 years. Forty-four were female with a mean age of 48.4 years and a mean duration of dialysis of 2.3 years. Hepatitis B exposure was 57% and 12.8% of haemodialysis patients were positive for HBsAg, whereas 39.8% of patients were positive for anti-HCV. There was a significant correlation ( P =0.00007) between anti-HCV positivity and the length of time on haemodialysis. However, there was no significant correlation found between the number of blood transfusions received and anti-HCV positivity. There was also no significant correlation found between HBsAg and antibodies to hepatitis B core antigen (anti-HBc) positivity and the number of blood transfusions or the length of time on haemodialysis, nor between hepatitis B and C exposure and elevated aminotransferase levels.     

Prevalence of hepatitis B and hepatitis C in haemodialysis patients

SUMMARY: The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B exposure and antibodies against the hepatitis C virus (anti-HCV) was assessed in 86 haemodialysis patients at the National Kidney and Transplant Institute (NKTI) using the commercial radioimmunoassay and ortho HCV ELISA assay. of the 86 patients included in the study, 42 were male with a mean age of 44.9 years and a mean duration of dialysis of 2.4 years. Forty-four were female with a mean age of 48.4 years and a mean duration of dialysis of 2.3 years. Hepatitis B exposure was 57% and 12.8% of haemodialysis patients were positive for HBsAg, whereas 39.8% of patients were positive for anti-HCV. There was a significant correlation ( P = 0.00007) between anti-HCV positivity and the length of time on haemodialysis. However, there was no significant correlation found between the number of blood transfusions received and anti-HCV positivity. There was also no significant correlation found between HBsAg and antibodies to hepatitis B core antigen (anti-HBc) positivity and the number of blood transfusions or the length of time on haemodialysis, nor between hepatitis B and C exposure and elevated aminotransferase levels.     

Prevalence of hepatitis C virus infection and related risk factors among Iranian haemodialysis patients

Hepatitis C virus (HCV) infection is common among patients undergoing haemodialysis, and liver disease is an important cause of morbidity and mortality in this population. Management of HCV-related liver disease is a major health concern in patients with end-stage renal disease (ESRD) undergoing haemodialysis. To investigate the prevalence of HCV infection in patients on haemodialysis and its associated risk factors, we conducted a prospective case series study of 838 patients on haemodialysis in Tehran, Iran. Patients were selected randomly (cluster sampling) and all were screened for anti-HCV antibodies, using ELISA 3rd generation and confirmed by using RIBA 2nd generation. We found that 111 patients (13.2%) were infected. By applying univariate analysis, longer duration on haemodialysis (P = 0.000), more weekly dialysis sessions (P = 0.03), history of blood transfusion (P = 0.03) and history of previous renal transplantation (P = 0.01) were found to be associated with a higher rate of HCV infection. Multivariate analysis revealed that only length of time on dialysis (P = 0.000) and history of blood transfusion (P = 0.02) were significantly associated with HCV infection. The more the units transfused, the higher the rate of HCV infection. Our results suggest that early transplantation and avoidance of blood transfusion, as much as possible, are the two most important practical interventions to reduce the HCV exposure rate in our patients on haemodialysis.     

Prevalence of and risk factors for hepatitis G (HGV) infection in haemodialysis patients: a multicentre study.

BACKGROUND: Hepatitis G virus (HGV) or GB-virus type C (GBV-C) is, like hepatitis C, a blood-borne virus and a member of the family of flaviviridae. HGV is distributed globally and is present in the volunteer blood donor population. Thus, for epidemiological reasons, HGV is of interest in haemodialysis patients, who are at risk of parenterally transmitted infections. The aim of the present investigation was to assess the prevalence of HGV by antibody testing and HGV-RNA determination by PCR. METHODS: The study was performed in haemodialysis units of the Patienten-Heim-Versorgung, an organization of haemodialysis units throughout Germany. A total of 2796 out of 3042 patients (92%) from 43 haemodialysis units were enrolled prospectively in the trial. Liver function tests were performed and epidemiologic data were obtained to evaluate risk factors for HGV in haemodialysis patients. RESULTS: Antibodies against HGV were detected in 485 patients (17.5%). Viraemia was seen in 380 out of 1935 patients tested (19.6%). Fifty-eight patients (3.0%) were positive for both antibodies and HGV-RNA. Using a standard questionnaire in 1717 out of the 2786 patients, it was found that more than five blood transfusions increased the risk of HGV infection significantly (P<0.05). There was no association found between HGV infection and the length of time on haemodialysis. CONCLUSION: HGV is common in German haemodialysis patients but, in contrast to other parenterally transmitted viruses, there is no further risk for new infections during haemodialysis, except for patients who have received several blood transfusions.     

Prevalence of risk factors for foot ulceration in a general haemodialysis population

It is well documented that diabetic foot ulceration contributes to increased morbidity and mortality associated with renal replacement therapy. Much less is known about the risk of foot ulceration and lower limb amputation in the non‐diabetic dialysis population. The aim of this study was to determine if the prevalence of risks factors for lower limb amputation in a stable haemodialysis population was greater in the diabetic cohort compared with the non‐diabetic cohort. The study design is a prospective observational cohort study. Sixty patients attending a satellite haemodialysis unit in Cardiff were invited to have a comprehensive foot assessment as part of a Podiatry service review. The medical notes and hospital information system were used to identify the diabetic cohort. Patients were classified according to diabetic status (diabetic versus non‐diabetic). The Renal Foot Screening Tool was developed to prospectively identify risk factors associated with foot ulceration. The assessment included peripheral neuropathy (PN), peripheral arterial disease (PAD) and foot pathology (FP). Fifty‐seven patients gave informed verbal consent prior to inclusion. Risk factors for foot ulceration were recorded at baseline in the diabetic (n = 24) and non‐diabetic (n = 33) groups and mortality data was revisited after a 3‐year period. FP was identified in 79% of patients. Eighteen per cent of the non‐diabetic patients had PN. PAD was identified in 45% of diabetic and 30% of non‐diabetic patients. Forty‐nine per cent of the total cohort had ≥2 of the 3 independent risk factors for foot ulceration (16/24 diabetic versus 12/33 non‐diabetic). The presence of PAD and PN was predictive of mortality independent of age. The limitations of this study are its small sample size and patients were from a single satellite dialysis unit. There was a high prevalence of risk factors for foot ulceration in this population, which were not confined to the diabetic cohort. These findings suggest that non‐diabetic patients on haemodialysis therapy are also at risk of developing foot ulceration. Further work on strategies to monitor and prevent FP in this high‐risk cohort is needed to minimize morbidity and mortality associated with foot ulceration.     

Prevalence of TT virus in a CAPD population

TT virus (TTV) has recently been identified in patients with post-transfusion non-A, non-G hepatitis. It is reported to be common in patients with a variety of liver diseases and with history of transfusion. Its pathogenesis in chronic liver diseases remains unclear. In this study, we have determined the prevalence of TTV in a continuous ambulatory peritoneal dialysis (CAPD) population and related its prevalence with history of previous hemodialysis, transfusion, HCV positivity and serum alanine amino-transferase (ALT) levels. TTV was detected in 44% of 63 CAPD patients and 30% of 43 healthy controls (p = 0.15). Frequency of TTV was similar in previously hemodialysed and never hemodialysed (8/14, 57% vs. 20/40, 41%, p = 0.15) and previously transfused and non-transfused (7/19, 37% vs. 15/44, 34%) CAPD patients. Prevalence of TTV was also similar in HCV(+) and HCV(-) patients. Serum ALT levels were 19 +/- 16 and 20 +/- 12 U/l in TTV(+) and TTV(-) patients, respectively. These results indicate that prevalence of TTV in a CAPD population is similar to healthy controls, and other routes of transmission in addition to parenteral routes might be involved in the transmission of TTV.     

Incidence and risk factors of hepatitis C virus infection in a haemodialysis unit

BACKGROUND: Hepatitis viruses have become one of the main infectious problems in patients on maintenance haemodialysis. The aim of this study was to prospectively investigate the incidence of de novo hepatitis C virus (HCV) infection in a haemodialysis unit and to identify factors currently involved in HCV transmission to haemodialysis patients. METHODS: One hundred and fourteen anti-HCV negative and HCV-RNA negative patients who started long-term haemodialysis were followed for a mean period of 36 months (range 18- 56). Liver tests and anti-HCV were performed at 6-month intervals. Factors that might be implicated in HCV transmission, such as blood transfusions, sexual habits, surgery and other invasive procedures, were recorded. HCV markers were re-examined in transfused blood and the HCV genotype was investigated in seroconverters to anti-HCV and in patients with previous HCV infection who were treated in the vicinity of those who seroconverted. RESULTS: Eight patients (7%) seroconverted to anti-HCV and seven of them became HCV-RNA positive. HCV markers, including HCV-RNA, were negative in the blood transfused to seroconverters. No differences between seroconverters and non- seroconverters. No differences found in other risk factors not directly related to haemodialysis. The investigation of HCV genotype suggested that HCV transmission was not restricted to patients treated in the vicinity of previously HCV infected patients. Occasional failure to observe strict measures of asepsis was detected in the haemodialysis unit and this was the only factor that might be incriminating. CONCLUSIONS: HCV acquisition in patients on haemodialysis is currently not related to blood transfusion, and nosocomial transmission within the haemodialysis unit seems to be the main mechanism of HCV infection. Extremely careful observation of preventive measures seems essential to eradicate HCV transmission in haemodialysis units.      

Anti-hepatitis C virus antibodies and hepatitis C virus viraemia in haemodialysis patients

Sera from 82 haemodialysis patients were tested for anti-HCV,HCV-RNA, and HBsAg. Alanine aminotransferase (ALT) activitywas monitored weekly for 2 months. Anti-HCV was positive in31 patients (37.8%), showing different single-peptide patterns.HCV-RNA was detected in 26 anti-HCV-positive patients (84%)and also in two of 21 anti-HCV-negative patients. Twenty-seven(87%) of the 31 anti-HCV-positive patients had persistentlynormal ALT values; 22 of these patients were HCV-RNA positive.The four patients with elevated ALT values had HCV viraemia.HBsAg was positive in nine anti-HCV-negative patients. The closecorrelation between HCV viraemia and HCV status, independentlyof ALT values, requires that anti-HCV dialysis patients mustbe considered potentially infective and dialysed with reservedmachines and/or in separate shifts.     

Hepatitis G virus infection in a haemodialysis unit: prevalence and clinical implications

Background. Hepatitis viruses have become one of the main infectious problems in patients on long-term haemodialysis. A new RNA virus, designated hepatitis G virus (HGV) has been recently identified. The pathogenic relevance of this virus is currently under investigation. The aim of this study was to analyse the prevalence and clinical implications of hepatitis G virus infection in patients on haemodialysis. Methods. The presence of HGV-RNA was investigated in 96 patients on maintenance haemodialysis. Hepatitis viral markers (HBsAg, anti-HCV, HGV-RNA) and liver tests were assessed in all these patients, as well as the risk factors for hepatitis viruses acquisition. As a control group, 200 blood donors were tested for the presence of HGV-RNA. Results. HGV-RNA was detected in 25 of 96 patients on haemodialysis (26%) and in six of 200 blood donors (3%) (P <0.001). Thirteen of 25 HGV infected patients (52%) were coinfected with other hepatitis viruses (HBV and/or HCV). Evidences of chronic liver disease were more frequent in patients infected by HBV and/or HCV (61%) than in patients infected by HGV alone (17%) (P = 0.01). Although 80% of HGV infected patients had received blood products, the transfusion rate was not different from non HGV-infected patients. Time on haemodialysis was significantly shorter in patients infected with HGV alone (3.1 ± 3.5 years) compared to patients infected with HBV and/or HCV (7.6 ± 5.8 years) (P = 0.04). Conclusions. Patients on maintenance haemodialysis are at increased risk for HGV infection. HGV infection itself does not seem to be a frequent cause of chronic liver disease in these patients. Since the prevalence of HGV infection in blood donors is high, blood transfusions could be one of the main factors implicated in HGV transmission in patients on haemodialysis.     

Hepatitis G virus infection in haemodialysis and in peritoneal dialysis patients

The aim of this study was to detect hepatitis G virus RNA (HGV RNA) and antibodies against the virus envelope protein E2 (anti-E2) in 107 patients either on maintenance haemodialysis (n = 78) or peritoneal dialysis (n = 29) to evaluate the prevalence of HGV infection and to establish its role in liver disease. The total prevalence of HGV infection was of 15.4% among haemodialysis patients, whereas it was 10.3% among peritoneal dialysis patients. HGV RNA was detected in 2 haemodialysis patients (2.6%) and in 3 peritoneal dialysis patients (10.3%). Anti-E2 was found in 10 haemodialysis patients (7.8%), whilst all peritoneal dialysis patients resulted negative. In only 1 patient the alanine aminotransferase level was elevated. This patient underwent liver biopsy that did not reveal evidence of chronic hepatitis. The lower HGV prevalence in haemodialysis patients, when compared with data reported by other European authors, should be related to the lower rate of polytransfused patients in our series (29.5%). Multiple blood transfusions should be considered as the main factor to explain the different prevalence of HGV infection among various European dialysis centres. Detection of both antibody and viraemia is important to establish the real rate of the infection.     

HLA genotypes and serum levels of hepatitis C virus RNA in Japanese patients on maintenance hemodialysis

Background. The prevalence of anti-hepatitis type C virus (HCV) antibodies in patients on maintenance hemodialy-sis (HD) is high, ranging from 5% to more than 50%. Although blood transfusion and/or impaired cellular immunity may contribute to HCV infection, the exact mechanisms remain undetermined. Here, we assess the role of HLA genotypes in chronic HCV infection in Japanese HD patients. Methods. Genotyping for HLA-A, B, and DRB1 was performed in 113 patients. All patients had anti-HCV antibodies in serum, and endstage renal disease treated by HD. Patients were divided into two groups – those with a low amount of HCV-RNA in their sera (group L; HCV-RNA <50 KIU/ml; n = 50) and those with a high amount (group H; HCV-RNA ≧50 KIU/ml; n = 63). Another group, of 264 Japanese patients on maintenance HD without HBV or HCV infection, served as disease controls. Results. The proportions of group L patients with HLA-B^*07, B^*46, and DRB1^*01 alleles and that of group H patients with HLA-B^*52 were significantly higher than those in the controls. On the other hand, the proportion of group H patients with HLA-DRB1^*04 was significantly lower than that in the controls. Conclusions. Our data suggest that HLA-B^*07, B^*46, and DRB1^*01 may be associated with the immunological elimination of HCV in Japanese patients on HD. Received: August 14, 2000 / Accepted: December 28, 2000     

Clinical characteristics and mortality in hepatitis C-positive haemodialysis patients: a population based study.

BACKGROUND: The association between hepatitis C virus (HCV) infection and clinical and laboratory measures in maintenance haemodialysis (MHD) patients are poorly understood. METHODS: We analyzed data from over 37,000 MHD patients who underwent MHD for at least 3 months in DaVita dialysis clinics across USA in July 2001. RESULTS: The presence of HCV infection was determined using enzyme immunoassay (EIA), which was performed in 2778 MHD patients and was positive in 363 (13%) individuals. In a multivariate logistic regression model that adjusts for case-mix and available surrogates of malnutrition-inflammation complex syndrome (MICS), the following were independent predictors of HCV infection: younger age, male gender, Black race, Hispanic ethnicity, higher haemoglobin, lower serum albumin, higher total iron binding capacity, higher creatinine, and higher serum glutamic oxaloacetic transaminase (SGOT). Among receiver operating characteristics of commonly measured laboratory values in this population, the SGOT had the highest area. An SGOT > or =25 u/l had an adjusted odds ratio of 4.96 (95% confidence interval: 3.75-6.57) for HCV antibody positivity (sensitivity 50%, specificity 87%). HCV EIA positivity among MHD patients younger than 65 years was associated with 40-80% higher hazard ratio of all-cause and cardiovascular death during the 2 year follow-up (July 2001 to June 2003) after adjustment for case-mix and measures of MICS. CONCLUSION: HCV infection, as diagnosed by EIA, has distinct racial, age and laboratory predilections in MHD patients. HCV positivity among MHD patients younger than 65 years is associated with significantly higher cardiovascular mortality. More diligent HCV detection and treatment may improve cardiovascular survival in MHD patients.     

Interferon treatment for hepatitis C virus infection in patients on haemodialysis

BACKGROUND: This study examined the efficacy and tolerability of interferon alpha-2b (IFN) in the treatment of chronic hepatitis C virus (HCV) infection in patients on maintenance haemodialysis. METHODS: A 24- month prospective cohort study was performed in 11 HCV RNA-positive haemodialysis patients, who were treated with IFN at 3 MU thrice weekly for 6 months. Serial biochemical and virological monitors included serum alanine aminotransferase levels, and HCV RNA by both qualitative PCR assay and quantitative bDNA assay. HCV genotypes were determined by PCR and nucleotide sequencing. Ten patients had baseline liver biopsy. RESULTS: HCV genotypes 1b and 2b were identified in 10 and one patients respectively. Six (55%) patients had biochemical and/or histological features of chronic active hepatitis before treatment. All 11 patients became HCV RNA-negative by PCR, with normalization of deranged aminotransferase levels, within 2-8 weeks of IFN therapy. HCV RNA reappeared in eight (73%) patients 2-8 weeks after the cessation of IFN, while biochemical relapse occurred in six (55%) patients. Sustained eradication of HCV was achieved in three (27%) patients. Sustained responders were characterized by pretreatment HCV RNA level < 3.5 x 10(5) Eq/ml as determined by the bDNA assay, and less severe histological abnormalities ('Total score' 1.7 +/- 1.2 compared to 5.4 +/- 2.2 in relapsers, P < 0.05). HCV RNA levels were similar before and after IFN treatment in non-responders and relapsers. Persistent malaise and poor appetite were noted in eight (73%) patients during IFN therapy. Other side-effects of IFN included the exacerbation of anaemia, induction of resistance to erythropoietin, weight loss, and reduced serum albumin level. CONCLUSIONS: Eradication of chronic HCV infection with IFN can be achieved in 27% of haemodialysis patients. Predictors of sustained response include low baseline HCV RNA level and mild liver pathology. Virological relapse can occur despite normal liver biochemistry. Exacerbation of anaemia, erythropoietin resistance, and malnutrition constitute the side-effects of IFN that deserve special attention in uraemic subjects.      

Incidence of seroconversion for hepatitis C virus in chronic haemodialysis patients: a prospective study

We conducted a prospective study in HD patients of our unitto evaluate the incidence of seroconversion for HCV in thishigh-risk group. Two hundred and thirty-five patients were observedduring the average follow-up of 29.4 months: 183 were seronegativeand 52 seropositive for anti-HCV antibodies at the start ofthe study. During the observation period two of 183 patientsdeveloped anti-HCV antibodies late in the study, while the other181 patients remained seronegative throughout the observationperiod; anti-HCV antibodies persisted through the follow-upin the 52 HCV-positive patients at the beginning of the study.Our results showed a very low incidence of HCV seropositivity(0.44% per year) after implementation of our operative protocolincluding ‘universal precautions’ and other infectioncontrol procedures. Once infected, there is no disappearancerate of anti-HCV. The 4-RIBA results did not change during thefollow-up period. Prevalence of HCV RNA by PCR technique was41% (22 of 54) among anti-HCV-positive patients. Future investigationsare warranted to clarify the exact route of transmission ofHCV among HD patients and to reduce the rate of HCV transmissionin this clinical setting.