NDT Advance Access published online on December 18, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn684
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Frequencies of hepatitis B and C infections among haemodialysis and peritoneal dialysis patients in Asia-Pacific countries: analysis of registry data
1 Australia and New Zealand Dialysis and Transplant Registry, Discipline of Public Health, University of Adelaide, Adelaide, Australia 2 Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia 3 Baxter Healthcare Pty Ltd, Shanghai, China 4 Division of Nephrology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan 5 Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea 6 Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India 7 Division of Nephrology, Third Hospital, Peking University, Beijing, China 8 Department of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan 9 Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Correspondence and offprint requests to: David Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane Qld 4102, Australia. Tel: +61-7-3240-5080; Fax: +61-7-3240-5480; E-mail: david_johnson{at}health.qld.gov.au
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Abstract |
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Background. The impact of dialysis modality on the rates and types of infectious complications has not been well studied. The aim of the present investigation was to evaluate the rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in peritoneal dialysis (PD) and haemodialysis (HD) patients in the Asia-Pacific region.
Methods. The study included the most recent period-prevalent data recorded in the national or regional dialysis registries of the 10 Asia-Pacific countries/areas (Australia, New Zealand, Japan, China, Taiwan, Korea, Thailand, Hong Kong, Malaysia and India), where such data were available. Longitudinal data were also available for all incident Australian and New Zealand patients commencing dialysis between 1 April 1995 and 31 December 2005. Rates of HCV and HBV infections were compared by chi-square, Poisson regression and Kaplan–Meier survival analyses, as appropriate.
Results. Data were obtained on 201 590 patients (HD 173 788; PD 27 802). HCV seroprevalences ranged between 0.7% and 18.1% across different countries and were generally higher in HD versus PD populations (7.9% ± 5.5% versus 3.0% ± 2.0%, P = 0.01). Seroconversion rates on dialysis were also significantly higher in HD patients (incidence rate ratio PD versus HD 0.33, 95% CI 0.13–0.75). HCV infection was highly predictive of mortality in Japan (relative risk 1.37, 95% CI 1.15–1.62, P = 0.003) and in Australia and New Zealand (adjusted hazards ratio 1.29, 95% CI 1.05–1.58). HBV infection data were limited, but less clearly influenced by dialysis modality.
Conclusions. Dialysis modality selection significantly influences the risk of HCV infection experienced by end-stage renal failure patients in the Asia-Pacific region. No such association could be identified for HBV infection.
Keywords: end-stage renal failure; environmental transmission; haemodialysis; hepatitis B; hepatitis C
Received for publication: 15. 8.08
Accepted in revised form: 17.11.08