Clinical-epidemiological and pathogenetic features of viral hepatitis C in the hemodialysis departments

Background. Today, the programmed hemodialysis belongs to the clinical medicine area where patients are at a constant risk of viral hepatitis infection. This is associated with surgical interventions on the vessels, fairly frequent transfusions of blood components, and regular hemodialysis procedures. But in recent years, the ratio of reported cases of viral hepatitis B and C in patients on programmed hemodialysis has changed significantly. With an abrupt increase in the incidence of viral hepatitis C, there is a decrease in the number of registered viral hepatitis B cases.

The aim. To study the clinical, epidemiological and pathogenetic features of viral hepatitis C in hemodialysis units.

Material and methods. A multicenter study was conducted that enrolled the patients from the Programmed Hemodialysis Units in Tashkent and the regional departments of the Republic of Uzbekistan. The study involved 395 patients on programmed hemodialysis for 7.5 ± 0.7 years. The age of patients was 43.5 ± 0.91 years. The diagnosis of chronic viral hepatitis C was made on the basis of medical history, clinical and laboratory data, and detection of anti-HCV IgG and RNA-HCV in blood.

Results. When analyzing the clinical examination and laboratory test results of 395 patients, the parenteral viral infection markers were detected in 181 patients (45.8%). The analysis of the overall incidence of viral hepatitis showed that chronic viral hepatitis C had the highest rates and was found in 125 patients (31.6%). The analysis of the chronic viral hepatitis C course in the presence of the end-stage chronic renal disease showed that in 11 (34%) of 32 patients of the Main group the disease proceeded as a fulminant form of chronic renal-hepatic failure with the development of adverse outcomes. Twenty seven patients (84%) in this group developed progressive anemia. In 16 patients (50%), persistent polyserositis developed in the form of hydrothorax, ascites, and pericarditis, which reflected the aggravating effect of chronic viral hepatitis C on the course of chronic renal disease.

Conclusions. In Hemodialysis Units, both in the city of Tashkent, and in the regional departments of the Republic of Uzbekistan, the incidence of chronic viral hepatitis C prevails, having the form of a pathological process with a minimally low activity. Chronic viral hepatitis C has an aggravating effect on the course of the underlying disease with the development of adverse outcomes.

1. Kuznetsov NI, Romanov ES, Startseva GYu. Modern principles of anti-viral therapy of hepatitis C. Russian Family Doctor. 2018;22(3):23–27. (In Russ.). https://doi.org/10.17816/RFD2018323-27

2. Arisheva OS, Moiseev SV, Kotenko ON. Daclatasvir and asunaprevir combination in hemodialysis patients with chronic hepatitis C. Clin Pharmacol Ther. 2016,25(3):5–10. (In Russ.).

3. Akimkin VG, Semenenko TA, Nikitina GYu, Godkov MA, Skvortsov SV. Epidemiology of hepatitis B and C in treatment and prophylactic institutions. Moscow: Bionics Publ.; 2013. (In Russ.).

4. Milovanova SYu, Milovanov YuS, Kozlovskaya LV, Komyagin YuV. Profilaktika i lecheniye virusnykh gepatitov B i C u bolnykh na programmnom gemodialize. Gepatologicheskiy forum. 2009;(4):19–26. (In Russ.).

5. Yarosh LV, Semenenko TA, Nikitina GYu, Shutov EV, Elgort DA, Feldsherova AA, et al. Prevalence of the hepatitis B and C viruses markers in the hemodialysis departments. Nephrology and dialysis. 2013;15(4):293–298. (In Russ.).

6. Gumilevskaya OP, Gumilevskiy BYu. Infektsionnyye oslozhneniya zamestitelnoy pochechnoy terapii. Lekarstvennyy vestnik. 2011;6(4):27–33. (In Russ.).

7. Dobronravov VA, Dunaeva NV. Renal damage and chronic hepatitis C Virus. Nephrology (Saint-Petersburg). 2008;12(4):9–19. (In Russ.). https://doi.org/10.24884/1561-6274-2008-12-4-9-19

8. Ivashkin VT. Immunnaya sistema i povrezhdeniya pecheni pri khronicheskikh gepatitakh B i C. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009;19(6):4–10. (In Russ.).

9. Fabrizi F, Verdesca S, Messa P, Martin P. Hepatitis C virus infection increases the risk of developing chronic kidney disease: A systemic review and metaanalysis. Dig Dis Sci. 2015;60(12):3801–3813. https://doi.org/10.1007/s10620-015-3801-y

10. Fabrizi F, Messa P. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. Int J Artif Organs. 2015;38(9):471–480. https://doi.org/10.5301/ijao.5000437