Keywords: Hepatitis C, Haemodialysis, Saudi Arabia.
|How to cite this article:|
Padmanabhan R. Hepatitis C Virus Infection in Haemodialysis Patients in Saudi Arabia. Saudi J Kidney Dis Transpl 1994;5:157-8
Hepatitis-C virus (HCV) infection has been recently recognized as an emerging problem in dialysis patients. The serological assay for anti-HCV antibodies developed by Kuo et al  has opened up new vistas in investigation of patients in general and haemodialysis (HD) patients in particular.
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Padmanabhan R. Hepatitis C Virus Infection in Haemodialysis Patients in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2022 May 24];5:157-8. Available from: https://www.sjkdt.org/text.asp?1994/5/2/157/41341
The carrier rate of hepatitis C antibodies studied worldwide is variable. The frequency of HCV infection in blood donors is 0.9% to 1% in USA, 1% Japan, 0.7% Italy and it is 1.5% in Saudi Arabia  . In the study conducted at King Khalid University Hospital, Riyadh along with National Kidney Foundation now renamed Saudi Center for Organ Transplantation (SCOT) involving 1,147 patients (580 Males and 567 Females) in 22 HD Centres in Saudi Arabia showed an overall prevalence of 68% (range 16-94%) and this study identified HCV as a major health problem in HD patients in Saudi Arabia  . The risk factors which correlated significantly with HCV infection in this study were (i) duration of haemodialysis (ii) blood transfusion (iii) nationality (iv) sex and (v) adherence to infection control. A similar study of HCV prevalence in Jeddah (152 patients) noted prevalence of 52% and significantly high incidence in patients on dialysis for more than 2 years and suggested that factors in dialysis unit may contribute to the spread  . In another study conducted at King Fahad Hospital Medina, involving 100 patients the incidence was 58% in HD patients  .
Four patients became positive for anti HCV antibodies after a period of negativity in King Fahad Hospital, Medina  . This seroconversion to positive was also noted in six out of 13 seronegative patients in Riyadh Armed Forces Hospital study  , involving 61 patients (anti-HCV antibodies positive in 70%).
The morbidity due to HCV in the form of elevated liver enzymes is mentioned in King Fahad Hospital, Medina study, which noted 21 out of 50 patients with hepatitis were suspected to be due to HCV  . Liver enzyme abnormalities were significantly high in anti-HCV positive patients in the study by Fabrizi et al  . In this study 12 out of 18 anti-HCV positive patients had elevated liver enzyme in contrast to 13 out of 159 in anti-HCV negative group (P<.001).
It is slowly emerging that blood transfusion is not the only source of infection and clearly other modalities are responsible. The study done by Fabrizi et al in Spain showed that 50% of anti-HCV positive patients had never received transfusion and several seronegative patients, had received 1-12 transfusions  .
Riyadh Armed Forces Hospital study by Saeed et al throws further light on nonhematogenous spread of HCV  . In this study out of 36 new patients recruited since 1989 in the erythropoietin era only 2 patients received blood transfusion and both were anti-HCV negative. Anti-HCV antibodies were positive in 14 patients (39%). They concluded that with high prevalence in HD patients against low background sero-prevalence in general population (1.5%), horizontal transmission between patients could be the mode of infection. They suggested isolation of sero-positive patients, like the Jeddah study  .
Three clinically important and relevant points highlighted by these studies in the Kingdom are;
- blood transfusion is clearly not the only mode of infection
- there is considerable morbidity due to HCV infection and
- duration of HD has been shown to be significantly associated with HCV infection in several studies, both in the Kingdom and abroad. The last finding, namely duration of HD requires further evaluation, with regard to factors in renal dialysis units like those related to patients, machines and paramedical personnel.
The Saudi Center for Organ Transplantation, which has admirably completed the preliminary study of Hepatitis C in 22 HD units in Saudi Arabia now has the wealth of data, which can be converted to clinical use by studying further say, by randomizing those 22 HD Centres into two groups. In one group separate machines should be used for anti-HCV antibody positive and negative patients and in the other group the present policy may be continued. This type of study will throw light on factors operative in renal dialysis units especially, those related to HD machines.
| References|| |
|1.||Kuo G, Choo QL, Alter HJ. An Assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 1989;244:362-4. |
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|4.||Berneih B, Allam M, Halepota A, Osman A, Pabker S, Tabakh A. Prevalence of Hepatitis C virus antibodies in hemodialysis patients in Medina Al Munawarah (Abstract). Saudi Kidney Dis Transplant Bull 1993;4(S1):73. |
|5.||Saeed AA, Al-Khader A, Suleiman M, Al-Admawi AM. Analysis of Hepatitis C virus infection in hemodialysis patients. Saudi Kidney Dis Transplant Bull 1993;4(S1):73. |
|6.||Fabrizi F, Di-Filippo S, Erba G, et al. Hepatitis C virus infection and hepatic function in chronic hemodialysis patients. Nephron 1992;61:119. |
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Consultant Nephrologist 29/2, Perumal 2nd Street, Madras 600 007, India
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