High Prevalence of Hepatitis C Virus Infection in Chronic Hemodialysis Patients

Hepatitis C virus (HCV) infection is very common among hemodialysis (HD) patients. Transmission of infection in this setting has been related to the number of blood transfusions, the duration of hemodialysis and to nosocomial transmission of virus in the dialysis unit. We conducted a study of 74 HD patients to determine the frequency of HCV at a single point in time (cross-sectional analysis), and to evaluate the association between HCV infection and patients' demographic, clinical and biochemical features. Serum samples were tested for anti-HCV antibodies using a third-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, third-generation recombinant immunoblot and HCV RNA detection by polymerase chain reaction (PCR) tests were performed. Collected data included the patient's age, gender, time on HD, number of blood transfusions and serum alanine aminotransferase (ALT) activity. Twenty-nine patients (29/74.4%) were found to be HCV positive using a third-generation ELISA assay. Of these 29 patients, 27 were also positive by recombinant immunoblot assay and 2 patients had indeterminate results. In the anti-HCV ELISA-positive subgroup, 20 (69%) of the 29 patients had detectable HCV RNA. The HCV RNA-positive patients had received more blood transfusions (15&plusm;3 vs. 5&plusm;1 units of packed red blood cells, p<0.0001) and had been on HD for a longer period of time than the HCV RNA-negative patients (65&plusm;32 vs. 32&plusm;29 months, p<0.0001). Mean serum ALT levels were significantly higher in the HCV RNA positive group (30&plusm;18 vs. 15&plusm;9, p<0.0001). We were unable to determine the most likely mode of transmission in our unit, but these results emphasize the need for strict adherence to blood collecting and handling precautions, careful attention to hygiene in the dialysis units, and sterilization of dialysis machines in order to properly combat this frequent infection.