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Li J, Yang Y, Gong M, Shi J, Zhou X, Xing X, Pan H, Guo S, Chang X, Cheng A, Wang Y, Ge S, Xiao F, Yao Y, Ning Y, He F, Xu G. Aggressive Quarantine Measures Reduce the High Morbidity of COVID-19 in Patients on Maintenance Hemodialysis and Medical Staff of Hemodialysis Facilities in Wuhan, China. KIDNEY DISEASES (BASEL, SWITZERLAND) 2020; 6:271-283. [PMID: 32903303 PMCID: PMC7316663 DOI: 10.1159/000508579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/07/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Maintenance hemodialysis (MHD) patients are highly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Medical staff of dialysis facilities without sufficient biosecurity protection are susceptible once exposed to asymptomatic coronavirus disease 2019 (COVID-19) patients. This study evaluated the epidemiological characteristics of COVID-19 in all MHD patients and medical staff of dialysis facilities in Wuhan, China. METHODS We collected COVID-19 morbidity and mortality data from MHD patients and medical staff from 52 hemodialysis centers in Wuhan. Then, we analyzed the symptoms and signs of patients and staff in our hospital (Tongji Hospital in Wuhan), and chest CT, SARS-CoV-2 nucleic acid detection and laboratory tests were performed. After aggressive quarantine of the COVID-19 patients, we followed up on the prognosis of them. RESULTS We analyzed the hemodialysis data from Wuhan and found that 10% of MHD patients and 6.0% of medical staff were suspected of COVID-19. Further detection of SARS-CoV-2 nucleic acid showed that 1.7% of MHD patients and 2.9% of medical staff were confirmed as having COVID-19. In our facility, 18.9% (46/244) of patients and 9.5% (6/63) of medical staff were suspected of COVID-19. Among them, 2.9% (7/244) of MHD patients and 4.8% (3/63) of medical staff tested positive for SARS-CoV-2 were confirmed as having COVID-19. Interestingly, 87.0% of MHD patients suspected of COVID-19 did not have obvious symptoms, but the CT screening showed features of viral pneumonia. There were no significant differences in symptoms, CT findings, comorbidity and laboratory findings of SARS-CoV-2 nucleic-acid-positive and -negative patients. We followed up these patients and found that 57 patients with COVID-19 died (COVID-19 mortality 8.9%). Two patients from our dialysis center with COVID-19 (mortality 4.3%) died. No new infections occurred in our dialysis center after aggressive quarantine was initiated. CONCLUSIONS The SARS-CoV-2 infection rates in MHD patients and medical staff in dialysis facilities were both high in Wuhan. Frequent chest CT and SARS-CoV-2 nucleic acid detection were needed to screen COVID-19 patients in dialysis facilities. Through the lessons of this experience on the aggressive diagnosis and quarantine measures of COVID-19 patients, we hope medical staff avoid more infections in serious epidemic areas.
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Affiliation(s)
- Junhua Li
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiling Gong
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Shi
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Zhou
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
| | - Xue Xing
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Pan
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuiming Guo
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Chang
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anying Cheng
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanan Wang
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Xiao
- Department of Gastroenterology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yao
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Ning
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan He
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kim AJ, Lee JH, Ko KP, Jung ES, Choi BH, Ro H, Jung JY, Lee HH, Chung W, Chang JH. Outcomes of hepatitis B surface antigenaemia in patients with incident end-stage renal disease. Nephrology (Carlton) 2017; 21:968-974. [PMID: 26617162 DOI: 10.1111/nep.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 12/22/2022]
Abstract
AIM Hepatitis B virus (HBV) infection is an important risk factor for morbidity and mortality in the general population. However, limited data are available on the progression of HBV infection in patients with end-stage renal disease (ESRD), and available data are controversial. Therefore, we investigated the association between hepatitis B surface antigen (HBsAg) seropositivity and mortality in patients with incident ESRD. METHODS All adult patients (≥18 years of age) starting dialysis for ESRD from January 2000 to December 2011 were included. A total of 1090 patients with ESRD were analyzed. HBsAg-positive patients were paired 1:6 with HBsAg-negative patients using propensity score matching. RESULTS Eighty one (7.4%) patients were HBsAg positive. No differences in the survival rates of the HBsAg-positive and HBsAg-negative patients with ESRD were detected in either the entire cohort or the propensity score matched cohort. No differences in survival were detected between the groups of HBsAg-positive patients based on the hepatitis B envelope antigen, hepatitis B envelope antibody, HBV DNA status, or use of antiviral agents. No difference in mortality was found between the haemodialysis (HD) and peritoneal dialysis (PD) subgroups among HBsAg-positive patients. CONCLUSION Our results suggest that hepatitis B surface antigenaemia is not related to increased mortality in patients with incident ESRD. Survival of HBsAg-positive patients undergoing PD was comparable to that of patients undergoing HD.
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Affiliation(s)
- Ae Jin Kim
- Department of Internal Medicine, Gachon University Gil Medical Center
| | - Jin Hwan Lee
- Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Kwang-Pil Ko
- Department of Preventive Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Eul Sik Jung
- Department of Internal Medicine, Gachon University Gil Medical Center
| | - Byoung Ho Choi
- Department of Internal Medicine, Gachon University Gil Medical Center
| | - Han Ro
- Department of Internal Medicine, Gachon University Gil Medical Center.,Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University Gil Medical Center.,Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Hyun Hee Lee
- Department of Internal Medicine, Gachon University Gil Medical Center.,Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University Gil Medical Center.,Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center. .,Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.
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Vidales-Braz BM, da Silva NMO, Lobato R, Germano FN, da Mota LD, Barros EJG, de Martinez AMB. Detection of hepatitis C virus in patients with terminal renal disease undergoing dialysis in southern Brazil: prevalence, risk factors, genotypes, and viral load dynamics in hemodialysis patients. Virol J 2015; 12:8. [PMID: 25644891 PMCID: PMC4329191 DOI: 10.1186/s12985-015-0238-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/02/2015] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Hepatitis C (HCV) is a serious public health issue, and it is estimated that 3% of the world's population is infected. Patients in hemodialysis units have an increased risk for contracting HCV, and high prevalence rates have been found in hemodialysis units around the world. This study is aimed at determining the prevalence of HCV in patients with terminal chronic renal disease (tCRD) who have been submitted to hemodialysis and peritoneal dialysis in southern Brazil to characterize the most prevalent genotypes, the viral load, and possible risk factors and to assess the validity between the ELISA and RT-PCR detection methods. Of 320 patients from three dialysis units, 318 participated in this study. According to the medical records, 55 patients were reactive to HCV, as determined via ELISA. All 318 samples were submitted to RT-PCR and genotyped using an Abbott Realtime m2000 system. Data obtained through a questionnaire and chemical variables were associated with the HCV. RESULTS The prevalence of HCV was 18.24% (58), and the concordance between the HCV serology and the RT-PCR was 94%. Three patients were diagnosed to be negative for HCV using the ELISA assay but positive when using RT-PCR. Genotype 1 was the most prevalent (46.7%) genotype, within which subtype 1a was the most frequent (74.1%). One of the risk factors associated with HCV infection was the length of time that the patient had been undergoing hemodialysis treatments (p < 0.001). Additionally, the viral load was found to vary when tested before and after hemodialysis (p < 0.001). CONCLUSION The prevalence of HCV in dialysis units continues to remain high, indicating nosocomial contamination. RT-PCR detected the presence of the hepatitis C virus in patients with a non-reactive serology, which highlights the importance of performing molecular tests on dialysis patients. The variation in the viral load in patients submitted to hemodialysis indicates a possible destruction or gripping of viral particles to the dialyzer membrane.
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Affiliation(s)
| | | | - Rubens Lobato
- Federal University of Rio Grande (FURG), Rio Grande, Brazil.
| | | | | | - Elvino J G Barros
- Federal University of Rio Grande do Sul (UFRGS), Porto alegre, Brazil.
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Fabrizi F, Lunghi G, Alongi G, Aucella F, Barbisoni F, Bisegna S, Mangano S, Romei-Longhena G, Artoni A, Bettoni G, Messa P, Martin P. Kinetics of Hepatitis B Virus Load During Haemodialysis Sessions and a-Interferon: A Prospective Study. ACTA ACUST UNITED AC 2013; 37:286-94. [DOI: 10.1159/000350156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2013] [Indexed: 11/19/2022]
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Risk factors of hepatitis during anti-tuberculous treatment and implications of hepatitis virus load. J Infect 2011; 62:448-55. [PMID: 21570123 DOI: 10.1016/j.jinf.2011.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/30/2011] [Accepted: 04/17/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Hepatitis during anti-tuberculous treatment (HATT) has been an obstacle in managing patients with tuberculosis (TB). We evaluate the risk factors of HATT and the clinical implications of serum viral loads in those with concomitant hepatitis B or C viruses (HBV/HCV) infection. METHODS We did a prospective study on patients with pulmonary tuberculosis in a medical center. HATT was defined as an increase in serum transaminase level of >3 times the upper limit of normal (ULN) with symptoms, or an increase in serum transaminase level of >5 times ULN without symptoms. RESULTS 360 TB patients were studied. The prevalence of concomitant HBV and HCV infection was 11.7% and 6.7%, respectively. HATT developed in 68 (18.9%). Cox regression analysis revealed that severe chronic kidney disease without hemodialysis, N-acetyltransferase (NAT2) slow acetylator, high initial HBV/HCV viral load, and women in those without HBV/HCV infection were significant predictors of drug-induced HATT, whereas severe chronic kidney disease without hemodialysis and men with high initial HBV/HCV viral load were significantly associated virus-induced HATT. CONCLUSION HBV/HCV viral load interacts with gender and, together with severe chronic kidney disease without hemodialysis and NAT2 slow acetylator, were predictors of HATT. TB patients with these characteristics need close follow-up.
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Mederacke I, Meier M, Luth JB, Schmidt-Gurtler H, Raupach R, Horn-Wichmann R, Wursthorn K, Potthoff A, Colucci G, Manns MP, Wedemeyer H, Tillmann HL. Different kinetics of HBV and HCV during haemodialysis and absence of seronegative viral hepatitis in patients with end-stage renal disease. Nephrol Dial Transplant 2011; 26:2648-56. [DOI: 10.1093/ndt/gfq757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Aghakhani A, Banifazl M, Kalantar E, Eslamifar A, Ahmadi F, Razeghi E, Atabak S, Amini M, Khadem-Sadegh A, Ramezani A. Occult hepatitis B virus infection in hemodialysis patients with isolated hepatitis B core antibody: a multicenter study. Ther Apher Dial 2010; 14:349-53. [PMID: 20609190 DOI: 10.1111/j.1744-9987.2009.00798.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg). Occult HBV infection harbors potential risk of HBV transmission through hemodialysis (HD). The aim of this study was to assess the occult HBV infection in hemodialysis patients with isolated hepatitis B core antibody (anti-HBc). A total of 289 HD patients from five dialysis units in Tehran, Iran, were included in this study. Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), anti-HBc, Hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of HD patients with isolated anti-HBc (HBsAg negative, anti-HBs negative and anti-HBc positive) by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler. Of 289 patients enrolled in this study, 18 subjects (6.2%, 95% confidence interval (CI), 3.5%-8.9%) had isolated anti-HBc. HBV-DNA was detectable in 9 of 18 patients (50%, 95% CI, 27%-73%) who had isolated anti-HBc. Plasma HBV-DNA load was less than 50 IU/ml in all of these patients. Our study showed that detection of isolated anti-HBc could reflect unrecognized occult HBV infection in HD patients. The majority of these infections are associated with low viral loads.
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Affiliation(s)
- Arezoo Aghakhani
- Clinical Research Department., Pasteur Institute of Iran, Tehran, Iran
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Moreira RC, Deguti MM, Lemos MF, Saraceni CP, Oba IT, Spina AMM, Nascimento-Lima AS, Fares J, Azevedo RS, Gomes-Gouvêa MS, Carrilho FJ, Pinho JRR. HBV markers in haemodialysis Brazilian patients: a prospective 12-month follow-up. Mem Inst Oswaldo Cruz 2010; 105:107-8. [DOI: 10.1590/s0074-02762010000100017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 12/01/2009] [Indexed: 11/22/2022] Open
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