Antibodies to hepatitis C virus (anti-HCV) were determined in an unselected group of 340 patients with chronic renal failure treated with maintenance dialysis. A second generation hepatitis C virus (HCV) enzyme-linked immunosorbent assay (ELISA) was used and confirmation made by a second generation recombinant immunoblot assay (RIBA). Sixteen patients (4.7%) were anti-HCV positive and 8 (2.4%) were anti-HCV indeterminate. All anti-HCV positive and anti-HCV indeterminate patients had received blood transfusions. No statistically significant differences were found between anti-HCV positive and indeterminate patients considering blood transfusions, dialysis and liver disease. The combined group of anti-HCV positive and indeterminate patients had had more blood transfusions (P < 0.005) and had been on dialysis for a longer period (P < 0.01) compared with anti-HCV negative patients. Further, significant correlation with elevation of transaminases and anti-HCV was observed (P < 0.001). Thirty patients (8.8%) had elevated transaminase levels and 13 (43%) of these were anti-HCV positive or indeterminate. In conclusion, HCV infection accounts for a substantial proportion of liver disease in dialysis patients, probably most often transmitted by blood transfusions but other routes of transmission could not be excluded.

SUMMARY1. We tested the hypothesis that afferent nerves from working muscles are important in determining the heart rate and blood pressure responses to brief maximal static exercise.2. In twenty human subjects, the heart rate and arterial blood pressure responses to a brief maximal voluntary handgrip were studied before and after axillary nerve anaesthesia or to maximal one-leg knee extension before and after epidural anaesthesia at L3-L4. Maximal knee extension could not be acomplished without performing a 'Valsalva-like' manoeuvre, but during handgrip it was possible to avoid the use of muscles other than those directly involved in the contraction. Heart rate and blood pressure were also monitored during a Valsalva manoeuvre of similar duration to the maximal voluntary contractions (4 s).3. During handgrip with normal breathing, axillary nerve anaesthesia reduced the heart rate response but had no effect on the blood pressure response.4. During a Valsalva manoeuvre, blood pressure increased but heart rate remained stable as long as expiratory pressure was maintained. During one-leg knee extension, epidural anaesthesia reduced the blood pressure response; however, the reduction in blood pressure was probably due to a reduction in the simultaneously performed 'Valsalva-like' manoeuvre.5. The results of this study suggest that afferent input from the working muscles is of importance for the heart rate responses to brief static muscle contractions. That such influence may be important for the blood pressure response remains unproven.

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