Prevalence of hepatitis B and hepatitis C in patients of chronic kidney disease
Keywords:Chronic Kidney Disease, Hemodialysis, Hepatitis B Virus, Hepatitis C Virus, Prevalence.
Background: Patients of CKD are highly exposed to HBV and HCV because of multiple blood transfusions and exposure to contaminated equipments. Infections by HBV and HCV are significant cause of morbidity in CKD patients by causing liver damage and membranoproliferative GN. Present study was done to observe the prevalence of HBV and HCV in patients of CKD and to compare the prevalence of these infections in patients who were on maintenance haemodialysis and who were not on maintenance hemodialysis.
Methods: This study had been conducted on 140 patients. Patients were diagnosed as having CKD on basis of Cockcroft-gault equation as per KDOQI guidelines. Stage 3, 4 or 5 patients were included for the study whereas patients with stage 1 or 2 were excluded. These 140 cases were divided into 2 groups, Group I included 70 cases who were on maintenance hemodialysis and Group II included 70 patients who were not on maintenance hemodialysis. The prevalence of HBV and HCV in the two groups was observed. Diagnosis of HBV was made by detection of HBsAg (one step immunoassay) and diagnosis of HCV was made by detection of antibodies to Hepatitis C(enzyme linked immunoassay). Prevalence data of NCDC was used for comparison with general population.
Results: In Group I, 15 (21%) patients were positive for HCV and 9 (12.9%) were positive for HBV which is significantly higher compared to Group II patients in which 6 (8.6%) and 2 (2.9%) were positive respectively. Overall out of 140 patients,21(15%) were positive for HCV and 11(7.9%) were positive for HBV, which is significantly higher compared to data of NCDC for general population in which prevalence of HCV and HBV is 1% and 4% respectively
Conclusions: Prevalence of HBV and HCV was significantly higher in patients of CKD than the general population, which was further higher in patients who were on maintenance hemodialysis and have received multiple blood transfusions, emphasizing the need to implement the methods to limit the spread of HBV and HCV.
Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet. 2001;357(9268):1601-8.
Cockcroft DW, Gault MH. Prediction of Creatinine Clearance from Serum Creatinineº. Nephron. 1976;16:31-41.
National Kidney Foundation: K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification and stratification. Am J Kidney Dis. 2000;1: 39.
Shankar BR, Aggarwal R and Nair SR. Epidemiology of hepatitis B in India: Sporadic vs transfusion associated infections. In Transfusion Associated Hepatitis, Diagnoses, Treatment And Prevention. 1st Ed. Eds Sarin SK and Hess G, N. Delhi, CBS Publishers and distributors. 1998;14-8.
López‐Alcorocho JM, Barril G, Ortiz‐Movilla N, Traver JA, Bartolomé J, Sanz P et al. Prevalence of hepatitis B, hepatitis C, GB virus C/hepatitis G and TT viruses in predialysis and hemodialysis patients. J med virol. 2001;63(2):103-7.
Agarwal S. Prevalence and association of hepatitis C viremia in hemodialysis patients at a tertiary care hospital. Ind J nephrol. 2009;19(4):172.
Chandra M, Khaja MN, Hussain MM, Poduri CD, Farees N, Habeeb MA,et al. Prevalence of Hepatitis B and Hepatitis C Viral Infections in Indian Patients with Chronic Renal Failure. Intervirol. 2004;47(6):374-6.
Reddy AK, Murthy KD, Lakshmi V. Prevalence of HCV infection in patients on haemodialysis: survey by antibody and core antigen detection. Ind J med microbiol. 2005;23(2):106.
Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial. 2005;18:52-61.
Ross RS, Viazov S, Clauberg R, Wolters B, Fengler I, Eveld K, et al. Lack of de novo hepatitis C virus infections and absence of nosocomial transmissions of GB virus C in a large cohort of German haemodialysis patients. J Viral Hepat. 2009;16(4): 230-8.
Nakai S, Suzuki K, Masakane I, Wada A, Itami N, Ogata S, Kimata N, Shigematsu T, Shinoda T, Syouji T, Taniguchi M. Overview of regular dialysis treatment in Japan (as of 31 December 2008). Therapeutic Apheresis Dialysis. 2010;14(6):505-40.
Kumar H, Naqvi SA, Ahmed A, Hamid S. Hepatitis-C virus antibodies anti HCV) in hemodialyzed vs non-dialyzed patients. J Pak Med Assoc.1994;44:28-30.
Muller GY, Zabaleta ME, Arminio A, Colmenares CJ, Capriles FI, Bianco NE, et al. Risk factors for dialysis-associated hepatitis C in Venezuela. Kidney international. 1992;41(4):1055-8.
Castillo L, Diaz P, Inostroza J. Prevalence of hepatitis C virus antibodies in chronic hemodialysis and kidney transplantation patients. Rev Med Chil. 1993;121(9)1024-8.
Tang S, Lai KN. Chronic viral hepatitis in hemodialysis patients. Hemodial Int.2005;9:169-79.
Chanpong GF, Laras K, Sulaiman HA, Soeprapto W, Purnamawati S, Sukri N, et al. Hepatitis C among child transfusion and adult renal dialysis patients in Indonesia. Am J Trop Med Hyg. 2002;66(3):317-20.
Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE, et al. Prevalence of and risk factors for hepatitis C (HCV) infection in haemodialysis patients: A multicentre study in 2796 patients. Gut. 2002;51(3):429-33.
Reddy GA, Dakshinamurthy KV, Neelaprasad P, Gangadhar T, Lakshmi V. Prevalence of HBV and HCV dual infection in patients on hemodialysis. Ind J Med Microbiol 2005;23(1):41-3.
Goral V, Ozkul H, Tekes S, Sit D, Kadiroglu AK. Prevalence of occult HBV infection in haemodialysis patients with chronic HCV.World J Gastroenterol. 2006; 12(21):3420-4
Modi GK, Jha V. The incidence of end-stage renal disease in India: A population- based study. Intern Soci Nephrol. 2006;70(12): 2131-3.