Hepatitis C in dialysis units: The Saudi experience

Abstract

Hepatitis C virus (HCV) infection is a significant health problem, as it can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Patients undergoing hemodialysis treatment are at increased risk of contracting HCV and other viral infections. This is primarily due to their impaired cellular immunity, underlying diseases, and blood exposure for a prolonged period. Transmission of viral hepatitis, and in particular HCV in dialysis units, has been showing a progressive increase worldwide, ranging between 5% in some western countries and up to 70% in some developing countries. The annual rate of HCV seroconversion in Saudi Arabia is 7% to 9%, while its prevalence is variable between 15% and 80%. This prevalence remained at almost 50% in recent years, despite the further increase in number of patients with end-stage renal disease and the expansion of dialysis services. The most prevalent genotypes in Saudi Arabia are genotype 4 followed by genotypes 1a and 1b, whereas genotypes 2a/2b, 3, 5, and 6 are rare. Genotypes 1 and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. Isolation of dialysis machines and infected patients, together with strict application of infection-control policies and procedures and continuous education and training of nursing staff, remain the cornerstone in prevention and control of the spread of HCV infection in dialysis units. Interferon (INF)-alpha or pegylated INF, alone or in combination with ribavirin, have shown great promise in the treatment of chronic HCV in dialysis patients.

The Prevalence of HIV, HCV, and HBV Among Hemodialysis Patients Attending Duhok Hemodialysis Center

“…In studies conducted in neighboring countries, such as Iran, Turkey, and Saudi Arabia, the prevalence of HCV in patients was 4%, 29%, and 20%, respectively (3,18). In Europe, the prevalence of infection ranged from 2% in the United Kingdom to nearly 20% in Spain and Italy (3,19,20).…”

Is Pre-Endoscopy Hepatitis B and C Testing Useful?

“…Due to the risk of transmission of hepatitis in the many dialysis centers around the world, dialysis machines used by patients with hepatitis, and even their rooms, are separated from other patients (14,15). However, no such separation of endoscopy devices, which are in direct contact with patient blood and secretions, is undertaken, even though such equipment may, in fact, have a higher risk of transmission than dialysis machines.…”

Advances in Hemodialysis Techniques

“…Post-dialysis care should ensure strict control of infection [18,19] and predominance of arterio-venous fistula (avoidance of indwelling catheters for vascular access) [20]. Furthermore, dialysis care should include (1) adequate control of body fluids (achievement of euvolemic status), where strict volume control has been shown to reduce both morbidity and mortality and dialysis ade-quacy outcomes [21,22], (2) mitigation of left ventricular hypertrophy and fibrosis, and (3) efficient removal of all types and different sizes of retained uremic toxic solutes that would result in inflammation and exacerbation of cardiovascular damage [20].…”