Prevalence of cytomegalovirus infection among patients undergoing hemodialysis

CMV diseases predominantly occur as an opportunistic infection in patients with severe immunosuppression, such as cancer and renal failure patients, and rarely occur in immunocompetent patients. This study aimed to investigate the prevalence of CMV infection in patients undergoing hemodialysis and to compare the results of different serological tests for CMV infection. Data were collected from 100 patients with renal failure and undergoing hemodialysis in the hemodialysis center of health insurance hospital in Tanta City, Gharbia Governorate, Egypt during the period from January 2007 to January 2008. The data collected from the study patients included sociodemographic characteristics, history of blood transfusion and duration of hemodialysis. CMV/IgG, CMV/IgM and CMV/Ampilcor (PCR) tests were done for each studied patients. Cross-tabulation and Fisher exacts and McNamar's tests as well as concordance agreement tests were used. The mean age of the study patients was 42.0 +/- 8.1 and most of them (60%) were males with the mean duration of dialysis was 1.8 +/- 1.1 years. The seroprevalance of CMV antibodies among these acute patients was 98% using CMV/IgG, 11% using CMV/IgM and 30% by using CMV/Ampilcor (PCR). Comparing these findings showed highly statistically significant difference (P = 0.001). Sensitivity and specificity of CMV/IgG and IgM were varied compared to CMV/Ampilcor test. The IgM was less sensitive (30%) but highly specific (97%), so PCR is the gold standard test with concordance estimated to be 28%. For this test, sensitivity and agreement is increased with decreasing years of dialysis to become 40% and 43%, respectively. On the other hand, however, CMV/IgG appeared to be highly sensitive (93%) and not specific at all (0%), and the agreement with PCR is very low (3%). In summary, the choice of diagnostic IgM and IgG tests depends upon the duration of hemodialysis that might primarily determine the duration of infection, although the use of PCR testing appeared to be more convenient.