Epidemiology of Viral Hepatitis in Dialysis Centers: A National Survey

Abstract

Because of the great problem of viral hepatitis in hemodialysis patients, the Italian Society of Nephrology decided to perform a national epidemiologic survey. We contacted 467 nephrological centers by a questionnaire which let us have information on 25,746 uremic patients: 18,338 on HD, 2,250 on PD and 5,176 with kidney transplant, respectively 78.5% of the total Italian dialysed patients and 91.4% of the total transplanted patients. Statistical analyses were performed. HBV infections occur in 7.8% of the patients (2,008 cases) but considering that 485 cases became spontaneously negative, the true overall incidence of chronic carriers falls to 4.9%. The main causes of the infection are reported as transfusions (64.3%) and dialysis environment (12%). The vaccination program performed by 93.2% of the centers, obtained an efficacious seroconversion in 4,626 of 7,790 cases vaccinated: the vaccine currently most utilized is the recombinant type administered by means of 3 versus 4 boosters. In the 2nd part of the survey, we report information concerning the presence of nephropaties associated with HBV infections in nonuremic patients (208 cases). We present and discuss the clinical picture of the nephropaties, the hystologic bioptic pattern and the prognosis of the kidney pathology.

Recombinant Hepatitis B Vaccine Use in Chronic Hemodialysis Patients

“…There are a few' authors [2][3][4] who evaluated prevalence and risk factors for HBV infection in HD patients. Nowa days there is availability of a recombinant vaccine to pre vent HBV infection among HD subjects; this vaccine seems to have solved several difficulties related to the use of a plasma-derived vaccine.…”

Hepatitis B viral infection in maintenance hemodialysis patients: A three year follow-up

“…China, a country hyperendemic for HBV infection, has a higher rate of HBV infection than most industrialized nations. That is why the prevalence rate of HBV infection in our hemodialysis patients is higher than previous observations from western countries (0.9%-5.9%) [11][12][13][14] as well as from other developing nations (4%-17%) [15][16][17][18][19] . In order to study the risk of HBV infection, we examined the time on hemodialysis, the biochemical data and the history of blood transfusions of the two groups of patients.…”

“…Introduction of HBV vaccination, isolation of HBV positive patients, use of dedicated dialysis machines and regular surveillance for HBV infection has dramatically reduced the spread of HBV in this setting [6][7][8][9][10] . However, the frequency of HBV infection in patients undergoing maintenance dialysis in the industrialized world is low, but not negligible [11][12][13][14] . Persistent HBsAg seropositivity is much higher in lessdeveloped countries [15][16][17][18][19] , especially in China.…”

The Relationship between Tumor Necrosis Factor-α Polymorphisms and Hepatitis C Virus Infection: A Systematic Review and Meta-Analysis

“…The declined immune function in uremic patients undergoing HD, especially the cellular immunity, together with defection of neutrophil function and complement activity, weaken the ability of resisting pathogenic micro-organisms and pathogenic virus in HD patients. 3,37,38 According to recent studies, HBV infection rate is 6-7.8% and HCV 20-30% in HD patients 39,40 and HD does not increase the prevalence of hepatitis B, but significantly increases hepatitis C infection rates. 41,42 The natural outcome of HCV infection varies dramatically among individuals.…”