Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences.
BACKGROUND
The prevalence of hepatitis C virus (HCV) infection in hemodialysis (HD) patients has decreased significantly in the course of the past decade in most HD units. The objective of this study is to analyze the causes of this reduction and obtain additional information for the near future that could be of use for health services planning.


METHODS
All patients who underwent HD in the Province of Cordoba, Spain, between January 1992 and December 2002 were studied. We analyzed annual exclusions from the HD program of HCV-positive patients (deaths and kidney transplantations) and inclusions (predialysis patients, patients with chronic graft rejection, and HD patients with acute HCV infection). The trend in the time series of measurements was calculated by means of exponential smoothing with 2 parameters.


RESULTS
In December 1992, the prevalence of antibody to HCV (anti-HCV) was 24% (N = 54), whereas by December 2002, it had decreased to 9.2% (N = 35). Of 657 predialysis patients included in the maintenance HD program, 2.8% (n = 19) were positive for anti-HCV. Annual mean incidence of acute HCV infection was 0.5%, and the median was 0.32%. Mean crude annual mortality rates were 12.2% for anti-HCV-positive patients versus 9.9% for anti-HCV-negative patients. The trend in this time series suggests that by 2006, the prevalence of anti-HCV in HD patients will be approximately 2.5%.


CONCLUSIONS
Causes implicated in the reduction in prevalence of HCV infection in HD patients are a greater mortality rate, stabilization of the incidence of acute HCV infection, and a low percentage of HCV infection in predialysis patients. By the end of 2006, the rate of HCV infection in HD patients will be very close to that of the predialysis population.
Espinosa
Mario
M
Servicio de Nefrologa, Hospital Universitario Reina Sofia, Cordoba, Spain. espinosahe@supercable.es
Martn-Malo
Alejandro
A
Ojeda
Raquel
R
Santamara
Rafael
R
Soriano
Sagrario
S
Aguera
Marisa
M
Aljama
Pedro
P
D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology