The Prevalence and Demographic Data of Patients with Hepatitis B Surface Antigen on Regular Haemodialysis in Al-Gharbia Governorate

Abstract

In recent decades, the use of hemodialysis has been expanded increasingly for end-stage renal disease. The modality of this treatment has led to the increased longevity of patients. It also predisposes these patients to some infections, mainly blood born viruses. HBV infection is a major public health problem in the Middle East; the majority of its countries have an intermediate or high endemicity of HBV infection, including Egypt. The prevalence of HBV infection varies throughout the world. Egypt has the highest number of reported infections. Viral hepatitis remains a major hazard for both patients and medical staff of haemodialysis (HD) units. Hepatitis B infections may occur in patients with end stage renal disease on renal replacement therapy (dialysis and/or trans-plantation). The prevalence of these infections is known to vary widely in different regions of the world. Liver disease runs a unique clinical course in dialysis patients, as it can progress with modest hepatic inflammation to prominent fibrosis. Liver biopsy appears to be the only definitive means to establish the activity of liver disease in dialysis patients. Many factors could be contributing towards this increased prevalence of viral hepatitis among dialysis patients. Some of these have been well documented, while others are still waiting further studies. These factors include:- blood transfusion, duration on haemodialysis holiday dialysis, dialysis in multiple centers and non-adherence to universal infection control precautions. Al Hijazat et al., (2008) recommended that: First; the importance of public health education particularly about the risk factors for hepatitis B, its prevention and control to minimize its transmission. Second; health-care professionals doing invasive procedures should be advised to use sterilized instruments and equipment to eliminate the chances of transmitting these infections. Third; only screened blood products should be transfused. Fourth; periodic screening for HbsAg, and vaccination should be administered to all patients with chronic kidney disease who might need HD. The prevalence of HBV infection in patients undergoing dialysis is greater than that in the general population suggesting that patients on dialysis may be at higher risk of acquiring HBV infection. Screening for HBV infection is essential to identifying HBV transmission that occurs in hemodialysis units. CDC recommends that all maintenance hemodialysis patients be screened for HBsAg and ALT level upon admission and that ALT testing be repeated monthly for HBV susceptible patients. Disease Outcomes Quality Initiative (KDOQI) also recommends that HBV infection screening be performed in patients who receive maintenance hemodialysis therapy. The importance of prevention of HBV infection and control is due to its well documented progression to hepatic cirrhosis, liver malignancies and liver failure. Our study was done on patients with positive HBsAg in the Hemodialysis unit of Tanta Tropical Hospital, Al-Mhala Tropical Hospital and Kafr-Elzayat Tropical Hospital.