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Int J Med Sci 2014; 11(5):436-441. doi:10.7150/ijms.8265 This issue Cite

Research Paper

Discrepancy between Serological and Virological Analysis of Viral Hepatitis in Hemodialysis Patients

Jer-Ming Chang^1,2,5, Chung-Feng Huang^3,6, Szu-Chia Chen^1,2,4, Chia-Yen Dai^3,4, Ming-Lun Yeh³, Jee-Fu Huang^1,3,4, Hsing-Tao Kuo^7,8✉, Wan-Long Chuang^3,4, Ming-Lung Yu^3,4, Shang-Jyh Hwang^2,5, Hung-Chun Chen^2,5✉

1. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan;
2. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
3. Hepatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
4. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
5. Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
6. Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan;
7. Division of Hepatogastroenterology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan;
8. Department of Senior Citizen Service Management Chia Nan University of Pharmacy & Science, Tainan, Taiwan.

✉ Corresponding authors: Hsing-Tao Kuo, M.D. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, 901 Chung-Hwa Rd, Yung-Kang City, Tainan 710, Taiwan. Tel: 886 6 2812811; Fax: 886 6 2828928 E-mail: khtchimei.org.tw And Hung-Chun Chen, M.D. Ph.D. Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University. 100 Shih-Chuan 1st Rd, Kaohsiung 807, Taiwan Tel: +886 7 3121101 ext 7351; Fax: +886 7 322872133 E mail: chenhcedu.tw. More

Abstract

Background and Aim: Viral hepatitis is a health threat for hemodialysis (HD) patients and it may be transmitted during treatment. Some patients categorized to have viral hepatitis were found to be non-viremic. To clarify the discrepancy between the serological tests in HD patients, we conducted the study.

Methods: A total of 1681 HD patients was included. Blood samples were analyzed for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody (anti-HCV). Detection of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA were performed in either HBsAg (+) or anti-HCV (+) samples. HBV DNA/HCV RNA was also measured in a subset of HBsAg (-) and anti-HCV (-) patients. Liver function tests were analyzed and compared with the serological and virological tests.

Results: The serological tests showed that 230 patients (13.7%) were HBsAg (+) and 290 (17.3%) were anti-HCV (+). We were unable to detect HBV DNA in 97 of 230 (42.2%) HBsAg (+) patients, and HCV RNA could not be found in 76 of 290 (26.2%) anti-HCV (+) patients. In 167 HBsAg (-) patients, only one showed a trace amount of HBV DNA. None of 151 anti-HCV (-) patients showed detectable HCV RNA. The prevalence rate of viral hepatitis remains high in Taiwanese HD patients: 13.7% for HBV and 17.3% for HCV. However, virological analysis showed 42.2% non-viremic rate for HBsAg and 26.2% non-viremic rate for anti-HCV.

Conclusions: The findings might challenge the presently suggested principles of bed and machine dedication and the diagnosis of viral hepatitis in HD patients.

Keywords: hepatitis B virus, hepatitis C virus, hemodialysis, viremia.

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