Letter to the Editor

Vox Sang 1993;65:331

Sham Madan Al-Mufti, Kuppoor, Katnei Nabeei El-Reshaid A. Sanad Is Dialysis Environment More A b raizarn Koshy Important Than Blood Transfusion

Public Central Health Blood Laboratory; Bank and Virus during Hemodialysis?

Department of Nephrology and Thuniyan

Al-Amiri Hospital; Al-Ghanim Gastroenterology Center, in Transmission Of Hepatitis c Faculty of Medicine, University of Kuwait, Safat, Kuwait

Hepatitis C virus (HCV) is transmitted parenterally, and antibody to HCV (anti- HCV) is frequently found in patients on he- modialysis. The prevalence of anti-HCV in hemodialysis patients has been reported to range from 1% in the UK [l] to 50% in Brazil [2]. The frequencyofanti-HCVpositivityhas been correlated both to the durationof dialy- sis and number of blood transfusions re- ceived [3]. However, the relative importance of these two possible modesof transmissionis not clear.

We have assessed the prevalence of anti- HCV (ELISA, second generation, Abbott, Chicago, Ill., USA) in blood donors and pa- tients on hemodialysis with a view to deter- mine the relative importance of blood trans- fusion and duration of hemodialysis in ac- quiring anti-HCV. Only repeatedly reactive samples were defined as truly positive.

14,548 blood donors and 94 patients, on hemodialysis for 1-144 months (m), were studied between April and October 1992 (ta- ble 1). Anti-HCV was positive in 67/94 (71%) patients. 40/67 (60%) anti-HCV-positive pa- tients and 18/27 (67%) anti-HCV-negative patients received 1-13 blood transfusions (x2 = 0.4, NS). Among the 58 patients who received blood transfusions, there was no

difference in the number of blood transfu- sions received between anti-HCV positive (3.052.2) and anti-HCV negative (2.2k1.4) patients. Anti-HCV positive patients were on dialysis for longer duration (46+37m, MkSD) than anti-HCV negative patients (22+22 m) t = 3.7, p<O.Ol. 35/67 (52%) had elevation of ALT and positive anti-HCV while only 3127 (11%) had elevation of ALTin the absence of anti-HCV (x’= 13.5; p<O.Ol). Gamma globulin levels were similar in anti- HCV positive (32+6 g/l) and negative (31k5 g/l) patients.

The prevalence of anti-HCV found in our patients on hemodialysis is the highest re- ported. Several factors may have contributed to the high seroprevalence. Some patients may have acquired anti-HCV through blood transfusions. The seroprevalence among blood donors in Kuwait was found to be 2.4%, which is higher than in Europe and the USA. However, since the receipt of blood transfusions was not correlated to seropreva- lence of anti-HCV, other factors must have been more important. Furthermore, 40% of the anti-HCV positive patients had never re- ceived blood transfusion. Patients who were anti-HCV positive were on hemodialysis for significantly longer period than patients who

Table 1. Preva- Tested Anti-HCV positive lence of anti-HCV Source

in blood donors and n n % hemodialysis pa- tients in Kuwait Blood donors 14548 352 2.4

Hemodialysis patients 94 67 71.0 Transfused 58 40 69.0 Not transfused 36 27 75.0

were anti-HCV negative. Although all he- modialysis procedures were done using dis- posable material, some contamination can- not be ruled out. Another factor that may have contributed is that health care activity was severely affected by the invasion of Ku- wait by Iraq in August 1990. In a study con- ducted in Kuwait prior to invasion by Iraq, the prevalence of anti-HCV in patients on dialysis was only 30% [4]. It is possible that under the constraints of occupation, war and disruption of normal hemodialysis environ- ments, there was increased spread of HCV. The exact mechanisms involved in the very high prevalence of anti-HCV found in Ku- wait in the immediate post-war situation re- quires further study. Duration of dialysis and disruption of normal dialysis facilities by war may be significant risk factors for the acquisi- tion of anti-HCV during hemodialysis.

.............................................. References

1 Mortimer PP, Coher BJ, Litton PA, Vander- velde EM, Bassedine ME Brind AM, Ham- bling MH: Hepatitis C virus antibody. Lancet 1989;ii:798. Machida J , Yamaguchi K, Ueda S , Yoshida M . Kusumoto Y, Nishimura Y, Futami G. lshii 1’. Watanabe T , Takatsuki K: High incidence of hepatitis C virus antibodies in hemodialysis patients. Nephron 1992:60:117-118. Muller GY, Zabaleta ME, Arminio A, Colme- nares CJ, Capriles FI, Bianco NE, Machado IV: Risk factors for dialysis-associated hepati- tis C in Venezuela. Kidney Int 1992;41:1055- 1058. Al-Nakib B, Koshy A, Kaloui M, Al-Ramahi S, Al-Mufti S , Radhakrishnan S, Al-Nakib W HepatitisC virus antibody in Kuwait. Vox Sang 1992;63:75-76.

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Abraham Koshy. MD Department of Medicine (x142-9UO7193JM54-0331

Kuwait University, PB 24921 13110 Safat (Kuwait)

0 1993 S. Karger AG. Basrl

Faculty of Medicine $2.7510