After beginning a screening program for anti-HCV in dialysis patients, a hospital in the Al-Qassim region of Saudi Arabia reported four patients with anti-HCV. The hospital raised concerns about transmission through its dialysis equipment. We began a cross-sectional study of dialysis patients to identify risk factors for anti-HCV.
Methodology
From Renal Dialysis Unit (RDU) logbooks and patient files we identified all patients treated in all RDUs (five) in Qassim since January 1992. We identified patients with anti-HCV from results of the screening program using a second generation ELISA (Abbott) test. We reviewed the medical records for symptoms and signs of hepatitis, liver function test results, transfusion of blood and its derivatives, surgery and hepatitis B markers. We interviewed all patients to supplement information on symptoms and to identify transfusions and other exposures outside the Qassim region.
Results
We identified 89 patients treated in RDUs and tested for anti-HCV. Forty-four had anti-HCV (prevalence rate [PR]=49%). RDU patients with anti-HCV were more likely to have symptoms and signs of hepatitis than anti-HCV-negative patients. The median SGPT for anti-HCV-positive patients (178 IU) was higher than that of anti-HCV-negative patients (34 IU) (p<0.0001; Kruskal-Wallis test). All RDU patients with anti-HCV had an SGPT >100 IU. RDU patients who had received three or more blood transfusions had a PR of 93% compared with a PR of 4.5% in patients who had received fewer than three transfusions (risk ratio [RR]=20.5, 95% CI 5.3, 80). Neither major nor minor surgery was associated with anti-HCV (RR=1.6; p=NS). Prevalence rates by hospital ranged from 19% to 75% (p<0.0001, chi-square test) and hospitals with a higher PR in RDU patients also had a higher PR in blood donors. Qassim blood banks had not regularly screened donors for abnormal liver function tests and only began screening for anti-HCV in 1992.
Conclusion
We believe that blood transfusion, rather than a defect in renal dialysis units or machines, was responsible for hepatitis C infection in these dialysis patients. Blood banks in Qassim should screen for abnormal liver function in addition to anti-HCV. Alternatives to blood transfusions for RDU patients need to be instituted.