Nephrol Dial Transplant (1999) 14: 1929-1933
© 1999 European Renal Association-European Dialysis and Transplant Association
Epidemiology of Helicobacter pylori in chronic haemodialysis patients using the new RIBATM H. pylori SIA
1 Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, 2 Chiron Corporation, CA, USA and 3 Division of Nephrology and Dialysis, Lecco Hospital, Lecco, Italy
Correspondence and offprint requests to: Fabrizio Fabrizi MD, Division of Nephrology and Dialysis, Lecco Hospital, via Ghislanzoni 22, I-23900 Lecco, Italy.
Background. There are few data concerning the epidemiology of H. pylori in patients on chronic haemodialysis (HD) treatment. These surveys concerned small populations and were made with ELISA technique. However, ELISA-based assays do not differentiate between strains of H. pylori that are associated with ulcers. Recent literature reports that formation of ulcers correlates strongly with the expression of cytotoxin-associated protein (CagA) and vacuolating cytotoxin (VacA) of H. pylori.
Methods. A novel serological test (RIBATM H. pylori strip immunoblot assay (SIA)) has been recently introduced, it uses the H. pylori lysate (Lys) along with two additional purified recombinant antigens derived from CagA and VacA of H. pylori.
Aim. To study the epidemiology of H. pylori using RIBATM H. pylori SIA among chronic HD patients and blood donors as a control group. In addition, the activity of H. pylori was analysed by immunoblot technique in a group of patients with documented ulcers and normal renal function.
Results. The prevalence of antibody towards H. pylori among HD patients, blood donors, and patients with documented ulcers was 56% (127/228), 53% (84/158), and 100% (21/21) respectively; the difference was significant (P=0.0001). The frequency of anti-H. pylori-positive individuals was significantly higher in patients with documented ulcers than HD patients and blood donors, 21/21 (100%) vs 211/386 (55%), P=0.0001. The frequency of antibody to H. pylori in the HD population was significantly associated with race (P=0.005); no relationship between anti-H. pylori antibody and numerous demographic, biochemical, and clinical features of patients was seen. The frequency of antibodies against virulent strains of H. pylori in HD patients and blood donors with H. pylori was 60% (76/127) and 61% (51/84) respectively; it was 86% (18/21) among individuals with documented ulcers. No significant difference among these three groups occurred.
Conclusions. The frequency of antibody towards H. pylori by RIBATM H. pylori SIA was high both in HD patients and blood donors; patients with documented ulcers and normal renal function had significantly higher frequency of anti-H. pylori antibody. The anti-H. pylori antibody rate among HD patients was strongly associated with race. The prevalence of antibody against virulent strains of H. pylori did not change among HD patients and control groups. Studies in large cohorts of HD patients with documented peptic ulcer disease are in progress.
Keywords: haemodialysis; Helicobacter pylori; immunoblot technique; peptic ulcer disease; virulent strains