[Epidemiology of chronic hepatitis B and C among dialysis patients in Switzerland]

Among patients with renal insufficiency undergoing chronic dialysis treatment, chronic hepatitis due to infection with viruses of the hepatitis B (HBV) or hepatitis C (HCV) type represents a serious medical problem. In contrast to other countries, detailed statistics on the prevalence of HBV and HCV infection are not available for dialysed patients in Switzerland.

The present study is based on a nationwide survey among the Swiss dialysis population which evaluated the prevalence of patients positive for either the HBs antigen (reflecting HBV infection) or anti-HCV antibodies (reflecting HCV infection) in 1999. From our survey we collected data on 1713 haemodialysis and 226 peritoneal dialysis patients, representing 92 and 65% of the respective dialysis populations in Switzerland.

Of all patients (haemodialysis and peritoneal dialysis), 6.59% were HBV or HCV marker positive (HBV: 1.44%, HCV: 5.05%). In haemodialysis patients the prevalence was clearly higher for HBV (1.63%) and HCV (5.72%) compared to patients undergoing peritoneal dialysis (0.88 and 3.09% respectively). Laboratory parameters of hepatitis--as evidenced by an increase in liver transaminases--were present in 4% of the entire dialysis cohort, 0.6% having an increase in ALAT beyond 1.5 times the normal range. Patients undergoing treatment in haemodialysis units which do not implement additional precautions to prevent the spread of HCV among patients were more likely to be HCV marker positive with laboratory signs of hepatitis. A similar correlation was observed between HBV or HCV marker positivity and the number of patients treated per haemodialysis unit. Finally, the percentage of HBV/HCV marker positive patients on the Swiss kidney transplant list is comparable with that of HBV/HCV marker positive patients in the entire dialysis population.