Backgrounds: Hemodialysis (HD) represents the main modality of RRT in Egypt and it constitutes a burden on the health care budget. In Alexandria province of Egypt, HD service is provided through fifty-seven HD units, which are categorized into twenty-one nonprofit units and thirty-six private for-profit HD units. Our aims were to study epidemiology and to assess the three-year survival of ESRD patients treated by HD in governmental hospitals in Alexandria province. Methods and Design: In the year 2016; the data of the patients were collected from all the governmental hospitals in Alexandria province, which comprised seven HD units containing 687 patients. In a cross-sectional arm of the study, demographic data, vascular access, HIV, HBV and HCV serology, the possible etiology of chronic kidney disease (CKD), associated comorbidities, and the routine laboratory variables were included. Furthermore, in a prospective phase of the study, a three-year-survival rate of the studied HD patients was recorded. Results: The total number of HD patients in Alexandria province during 2019 was totaled to be 3552 in all HD units, so the estimated HD prevalence rate would be around 710 ppm. Demographic data of the surveyed 687 patients in the governmental HD units showed their mean age; 50.78 years with more males, and their mean duration of HD; 55 months. It was also noted that there was no positive seroconversion regarding HCV, HBV nor HIV. Sixteen HCV antibody-positive patients received direct-acting antiviral drugs and were converted to HCV PCR-negative. HTN was more common etiology of CKD in males, while DM and combined DM and HTN were more common in females. The target hemoglobin level was present in around 37% of the studied HD patients. Most of the studied patients had serum calcium ranged from 8-10 mg /dl and 53% of them had serum phosphorus ranged from 3-5.5 mg /dl. Para-thyroidectomy was done for 2% of the studied patients while 4% of cases received cinacalcet. The 3-year, 5-year and 7-year survival rates were 92.5%, 87%, and 82% respectively. Conclusion: The epidemiology of hemodialysis patients in Alexandria province is not different in many aspects from other published data about some Egyptian governorates however there is no published new epidemiology about the whole country. 11.2% of HCV Abs positive became PCR negative after antiviral management protocol.
Background: Hepatitis b virus infection (HBV) was recognized as an important hazard for patients and staff in Hemodialysis Units (HDU), and this issue was first recognized in the 1960s with a set of guidelines for the control of HBV in HDU. HCV is a blood-borne infection and is the most significant cause of viral hepatitis which is mainly transmitted by blood transfusion. Thus, it is reasonable to perform initial screening for HCV in HD patients. Patients admitted or re-admitted to an HD unit are recommended to be tested for HBsAg, HCV, and HIV antibodies and to be followed up monthly or at least every three months after admission to HDU. We aim to present this case of spontaneous clearance of HBV and HCV positive after being positive for more than twelve years on HD. Case Presentation: A 66 years old Egyptian male patient with Chronic Kidney Disease (CKD) from Alexandria had started HD 14 years ago while he tested positive for HCV-Ab and HBs Ag positive, although fared well with normal liver function, while the source of infection was not known. HCV-Ab turned into seronegativity after twelve years on HD. Astonishingly, after 13 years on HD; the test of HBs Ag became negative and hepatitis B surface antibody appears by Elisa testing. This was noticed or observed following the implementation of quality enhancement of the HD parameters in most of the HD services provided units according to the regulations of Ministry of Health (MOH), and this was accompanied by better anemia and more frequent utilization of high flux dialysis with a consequent reduction to the need for blood transfusion in the last four years. Previous publications advocated hypothetical mechanisms of HCV clearance during the process of HD: namely, filtration of the virus particles through the pores of the dialysis membrane and or their adsorption to the HD membrane. These welcome spontaneous clearances of the HBV and HCV in this patient could be attributable to the improvement of anemia state and use of high flux dialysis that might have improved the immunity of this patient. Conclusion: Spontaneous clearance of HBV and HCV could potentially possible and could benefit from the improvement of both patients and HD states that could enhance the immune system or mechanical entrapment of the virus particles. Suggestions need further studies for confirmation.
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