High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies

Non-A, non-B is a major form of hepatitis in haemodialysis (HD) patients. Hepatitis C virus (HCV) has been recently identified as the leading cause of non-A, non-B hepatitis in HD. A variable prevalence of hepatitis in HD has appeared in the literature, ranging between 1% and 29% in the Western world, and between 30% and 54% in Saudi Arabia, but all these reports used first-generation ELISA. Using second- generation enzyme immunoassay, we conducted a multi-centre study involving 22 HD centres all over Saudi Arabia in order to establish the prevalence and risk factors for HCV in HD patients in Saudi Arabia. A total of 1147 patients were studied, with a mean age of 43.4±15.3 years. Five hundred and eighty were males and 567 were females. The overall prevalence rate of positive anti-HCV was 68%, with a range from as low as 14.5%, to 94.7%. To our knowledge, this is the highest value reported among dialysis patients world-wide. A positive correlation was found between anti-HCV positivity and male sex (P=0.005), longer duration on dialysis (P=0.002) and blood transfusion (P=0.003). However, interestingly 62.6% of the patients who had not had blood transfusion had anti-HCV antibodies. HCV antibodies were also found more frequently in Egyptians, Pakistanis and Yemenis than in Saudis. A comparison between those centres with low prevalence of positive HCV and those with high prevalence regarding risk factors was carried out, and it was found that the major difference between them was the adherence of the staff to universal infection precautions. In conclusion, HCV is a major health problem in HD patients in Saudi Arabia. Identifiable risk factors are longer duration in dialysis, blood transfusion, male sex, nationality and most importantly the lack of adherence to universal infection precautions