International Society of Nephrology.

No abstract

Hepatitis B (HBV) and C (HCV) viruses are the most important infections transmitted by the parenteral route in patients receiving maintenance dialysis. The prevalence varies markedly from country to country. The aim of this study is to review the efficacy of the strategies to reduce the incidence of these infections and the trend of results in Iran. As a routine, all hemodialysis patients in Iran have biannual blood samples for assessment of serum HBSAg, HBS Abs, and HCV Abs. The data are collected in the Ministry of Health. For statistical analysis, prevalence, and incidence were calculated. There is an increasing prevalence/incidence of end-stage renal disease (ESRD) in Iran, from 238/49.9 pmp in 2000 to 357/63.8 pmp in 2006. The prevalence of positive HBSAg and HCV Abs decreased from 3.8% and 14.4% in 1999 to 2.6% and 4.5% in 2006, respectively. Regarding the genotype distribution in Iran, no one was found with genotype 2. On the subject of decreasing HBV infection, our next strategy should be mandatory vaccination in dialysis centers and in the pre-ESRD period. Concerning HCV infection prevention, 2 approaches may be recommended: the first is decrease of duration of the hemodialysis period by possible early transplantation of suitable patients. The next is a strictly enforced isolation policy for HCV-positive patients, which may play a role in limiting HCV transmission in HD units, and universal precaution in dialysis units should be under constant close surveillance.

The achieved standard of renal replacement therapy (RRT) in Tehran province, Iran is acceptable and in some aspects is comparable with European countries, but the number of ESRD patients is increasing in Tehran and worldwide. Increases in the number of HD centres, machines, shifts and kidney transplantations are taking place but cannot keep pace with the increasing number of patients. It is highly recommended that we try to increase peritoneal dialysis (PD) coverage and cadaveric transplantation, while keeping in mind that the prevalent population of individuals with CKD is estimated to be at least 20 times the number with ESRD. It is not too ambitious to consider CKD prevention, and we should place initial focus on strategies and treatments that slow disease progression, in order to postpone RRT.