Hepatitis B and Hepatitis C virus infections among patients with chronic kidney disease from two presumed high-risk centers

Abstract

INTRODUCTION AND OBJECTIVES: Community prevalence ofhepatitis-C (HCV) and hepatitis-B (HBV) infection is low in Sri Lanka. Patients with chronic kidney disease (CKD) are at high-risk for HBV and HCV infections. We determined the prevalence and risk factors for HBV and HCV among CKD patients in two Teaching Hospitals. METHODS: This cross-sectional, descriptive study was carried out among CKD patients at Nephrology Units in Polonnaruwa and Ragama Teaching Hospitals. CKD was defined as estimated glomerular filtration rate <60ml/min/1.73m2. Consecutive, consenting adult CKD patients with at least one blood transfusion during the past five years were included. All participants were tested for HBsAg and HCV antibodies by ELISA. Those found to be positive for either underwent confirmatory PCR testing. RESULTS: 232 patients were included [Mean-age: 55.83 years; 156 (59.75%) males]. Diabetes mellitus and/or hypertension were the causes of CKD in 137/232 (59.1%). 82/232 (35.3%) had CKD of uncertain aetiology.153/232 (65.9%) were on hemodialysis and 6/232 (2.6%) had received a kidney transplant. One was an intravenous drug user, 3 had tattoos and 86/232 (37.1%) had practiced unsafe sex previously. 145/232(62.5%) had previously received HBV vaccination and 67/232 (28.9%) had received 3 doses of the vaccine before first blood transfusion, hemodialysis or transplant. Sero-conversion testing was not done in 178/232 (76.7%). Six were previously HBsAg positive. On re-testing 4 were positive for HBsAg While none had HCV antibody positivity. All were negative for HBV-DNA on PCR testing. CONCLUSION: Active HBV,HCV infections were not detected in this cohort of CKD patients. Traditional risk factors were uncommon. Complete HBV vaccination was suboptimal and checking for seroconversion was low.