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Hepatitis C in Renal Dialysis Unit Patients in Qassim, Saudi Arabia.


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.


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.


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.


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.