Hepatitis C Patients on Maintenance Hemodialysis Show Complex Immune Disturbances in the Peripheral Blood

Ineffective Protection in Hemodialysis Patients: Sociodemographic and Clinical Context

PURPOSE

To analyze the association between components of the nursing diagnosis ineffective protection (00043) and sociodemographic and clinical data of hemodialysis patients.

METHOD

Cross-sectional study was conducted during the first half of 2015 with a sample of 200 patients from a reference clinic of nephrology. A structured instrument containing operational definitions was used to collect data.

FINDINGS

Hemodialysis patients presented defining characteristics of ineffective protection (00043) associated with sociodemographic and clinical context variables.

CONCLUSION

Components of this diagnosis may be influenced by sociodemographic and clinical context of hemodialysis patients.

Study of peripheral blood natural killer cells, T-cell helper/T-cell suppressor ratio and intercurrent infection frequency in hepatitis C seropositive prevalent hemodialysis patients

Hemodialysis (HD) may adversely affect the immune system. It is established that intercurrent infection rate and severity may be increased in prevalent HD patients. Moreover, hepatitis C viral infection, a common infection in many HD centers, may further inhibit the immune system. To our knowledge, no previous study in the literature has attempted to investigate the possible effects of hepatitis C seropositivity on rate and severity of intercurrent infection in prevalent HD patients. The aim of this study was to assess the peripheral blood CD16-natural killer cells, CD4/CD8 ratio, as well as rate of intercurrent infection in hepatitis C seropositive prevalent HD patients as compared with hepatitis C seronegative prevalent HD patients. Twenty hepatitis C seropositive stable prevalent HD patients (group A), as well as another twenty hepatitis C seronegative stable prevalent HD patients (group B), were randomly selected from our HD unit and enrolled in the study. Both groups were similar in age, sex, body mass index, and duration of HD. Diabetics, smokers, and cases with advanced liver disease (Child classification stages B and C) were excluded from the study. A third group (group C) of 10 apparently healthy subjects (of similar age, sex, and body mass index), was also enrolled in the study. All subjects were investigated by complete blood count, routine chemistry, assessment of peripheral lymphocytes CD3,CD16, CD4, CD8, CD4/CD8 ratio by flow cytometer, as well assessment of intercurrent infection frequency retrospectively (since the start of HD therapy and seroconversion in HD patients, and prospectively for a period of six months. Although we detected statistically significant higher frequency of intercurrent infection in both HD groups compared with the healthy group, we did not detect significant differences between hepatitis C seropositive and seronegative groups regarding frequency or severity of intercurrent infection. Moreover, we did not detect significant differences among the three studied groups regarding levels of CD16, CD3, CD4, CD8, CD4/CD8 ratio in peripheral lymphocytes. It may be concluded that hepatitis C seropositive prevalent HD patients are not at increased risk of intercurrent infection as compared with hepatitis C seronegative prevalent HD patients, contrary to what is reported in hepatitis C seroconverted organ transplant candidates.