Non-A, non-B hepatitis and chronic dialysis--another dilemma

To define the incidence of non-A, non-B (NANB) hepatitis and evaluate possible risk factors, we reviewed records of 163 patients on chronic dialysis during a 3-year period. 23 cases of NANB hepatitis occurred, 13 (27%) in 49 center dialysis, 8 (10%) in 77 home hemodialysis (p less than 0.02) and 2 (5%) in 37 peritoneal dialysis patients (p less than 0.01). Hepatitis patients received significantly more transfusions than controls. Numbers of transfusions and of patients transfused were not significantly different in center patients compared to home and peritoneal. 8 NANB patients received no transfusions. NANB was the most common cause of hepatitis in our unit (68%). Although transfusions were a likely etiologic factor, to explain the increased risk in center dialysis patients, disease in patients not transfused and development of NANB hepatitis without a known parenteral exposure in a physician assigned to the Nephrology Service, we feel another etiologic factor was important, the dialysis center.