Hepatitis C in dialysis patients: Relationship to blood transfusions, dialysis and liver disease

Abstract

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.

High Incidence of Hepatitis B Virus Infection in Hemodialysis Patients at Sanglah General Hospital and It’s Risk Factors

“…The risk of HBV transmission from blood contaminated items in this setting is greater and more serious than would be e pected for other common blood borne viruses. 1,2,4 In general the observed incidence of HBV infection (7.5%) is higher to the general population and higher than reported in HD patients in other regions including Europe (4.1%), Japan (2.2%) and the USA (2.4%). 18 A study sample from the dialysis outcome and practice patterns study that included 8615 adult HD patients from 308 dialysis facilities in Western Europe and the United States, reported incidence rates for HBV infection ranging from 0-6.6%.…”

“…2 Prior to effective screening of blood donations, HBV infection was associated with blood transfusions needed to correct the anaemia associated with kidney disease but patient to patient transmission in HD units is also reported. 3,4,5,6 HBV infection is usually due to patient to patient transmission within HD units. 7 Recognition of the risk of nosocomial infection has resulted in recommendations that strict infection control procedures should be in HD units; patients with blood-borne virus infections should be isolated from sero-negative patients during dialysis and patients as well as staff should be vaccinated against hepatitis B.…”

Anticorpo contra o vírus C da hepatite em pacientes sob programa de hemodiálise em Salvador, BA, Brasil

“…Os trabalhos realizados com RIBA III em pacientes sob hemodiálise apontam para alguns aspectos interessantes com relação à freqüência da positividade das frações. KNUDSEN et al (16) observaram que 15 de 16 pacientes hemodialisados anti-VHC positivos foram positivos para o c33c e todos foram positivos para o c33c ou c22-3, ambos característicos dos testes de segunda geração, enquanto 7 de 16 positivos não reagiram com c100-3 ou 5.1.1, antígenos utilizados nos testes de primeira geração. Estes dados reforçam o valor diagnóstico dos testes de segunda geração neste grupo de pacientes.…”

Clinical Impact of Hepatitis C Virus Infection in the Renal Transplant Recipient

“…Genotyping and viral load are only helpful to evaluate the efficacy of a planned virostatic treatment. Liver enzymes remain within normal limits despite HCV infection in 80 % of infected dialysis patients [22, 23, 24]. This can be due to several reasons: (1) chronic hepatitis C characteristically has fluctuating course with multiple peaks and troughs in ALT levels; (2) HCV infection is not always associated with chronic liver disease; in fact only 80% of anti-HCV positive symptom-free HCV RNA positive blood donors showed histologic signs of chronic hepatitis [23]meaning that there are also HCV RNA-positive healthy carriers; (3) baseline ALT levels are depressed in patients on dialysis [25].…”