PREVALENCE AND RISK FACTORS OF HEPATITIS B AND C VIRUS INFECTIONS AMONG HEMODIALYSIS PATIENTS FROM PRIVATE HEMODIALYSIS UNITS IN SURABAYA, INDONESIA.

The aims of the present study were to profile seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and possible risk factors among hemodialysis (HD) patients in private hemodialysis units (HDU) in Surabaya, Indonesia. Sera were obtained from 180 HD patients in 4 different private HDUs and tested for hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV). Patients without HBsAg and anti-HCV at first sampling were followed serologically every 3 months for 9 months, while those with HBsAg or anti-HCV positive sera were subjected continually to PCR to detect HBV DNA and HCV RNA. The prevalence of hepatitis infections varied widely between the HDUs, from 0% to 8.1% of patients positive for HBsAg and 0% to 60.6% of those positive for anti-HCV, respectively. These values were markedly higher than those among the general population, but not as high as in governmental HDUs in Indonesia. New incidence of HBV was not detected in any HDU, whereas that of HCV was found in two HDUs, HCV-1b in one HDU and HCV-1a in the other. Inappropriate practices were observed, such as shortage of medical staff and malfunctions in infection-control committees. Prevalence of HBV and HCV infection among HD patients in private HDUs were high and varied among the HDUs. Isolation of both HBV- and HCV-infected patients and staff education should help to reduce the prevalence of hepatitis infections in HDUs.

Detection and prevention of chronic kidney disease in Indonesia: initial community screening.

AIM: This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m(2)) and its risk factors amongst subjects from urban and semi-urban areas. METHODS: History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according Cockcroft-Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and Chinese MDRD equations. RESULTS: Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%. Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and 19.8%, respectively. CONCLUSION: The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.