[Prevalence and incidence of hepatitis C seroconversion in patients on hemodialysis]. / Prevalencija i incidencija serokonverzije hepatitisa C u pacijenata na hemodijalizi.

INTRODUCTION: Patients on hemodialysis belong to a high risk group of patients that are exposed to viral hepatitis. The aim of the study was to evaluate the prevalence and incidence of HCV infection seroconversion in this high risk group of patients. PATIENTS AND METHODS: Patients were followed up from January 1997 until January 2002. During this five-year period, the dialysis population increased. There were 99 patients (58 m/41 f) in January 1997, 43 of them seropositive. Out of 186 patients recorded in January 2002, 44 had anti-HCV antibodies. The following parameters were recorded: sex, age, hemodialysis duration, number of blood transfusions, and hepatitis markers. HCV antibodies were determined by third--generation ELISA method (Behring). RESULTS: The study included 164 patients (75 f/92 m), mean age 47.2 +/- 4.2 years, and mean hemodialysis duration 6.2 +/- 4.2 years. In January 1997, HCV antibodies were detected in 43/99 patients with a prevalence of 43.51%. During five-year follow-up, the highest prevalence of hepatitis C was 44% in 1998, with an extremely high incidence of 40% (8 patients became seropositive). In the first three years of the follow-up, the number of blood transfusions and duration of hemodialysis were the main risk factors for HCV transmission. The mean length of hemodialysis of seropositive patients was 6.92 +/- 4.23 in seropositive patients and 2.44 +/- 1.82 in seronegative patients (p < 0.001). Anti-HCV positive patients received significantly more blood transfusions (8.2 +/- 4.36) as compared to seronegative patients. Upon the introduction of preventive measures in 2000 and 2001, which included strict disinfection of monitors and working surfaces, connecting anti-HCV positive and anti-HCV negative patients to different machines, and use of erythropoietin, the incidence rate decreased, and in January 2002, it was 11% with a prevalence of 25%. CONCLUSION: HCV infection is frequent among hemodialysis patients. The number of blood transfusions and duration of hemodialysis as well as sharing the same dialysis machines were the main risk factors of transmission of HCV infection. The use of erythropoietin and preventive measures, along with the use of appropriate protocols and separation of HCV positive from HCV negative patients led to a decrease in the prevalence and incidence of hepatitis C in our hemodialysis population.

[Efficiency of high-flow dialyzers in removal of beta-2-microglobulin]. / Efikasnost visokoprotocnih dijalizatora u odstranjivanju beta-2-mikroglobulina.

BACKGROUND: [corrected] Beta-2-microglobulin (beta 2M) is protein with a molecular weight of 11.800 Daltons. A 30-fold or greater increase is found in patients(pts) over 10 years (ys) on haemodialysis (HD). The main aim of study is to evaluate high-flux (HF) dialyzer efficacy on beta 2M removal. METHODS: A sample of 15 pts was selected, 9 males and 6 females, aged 45.7 ys (31.60), mean duration on HD 156,3 months. All pts were dialyzed by standard bicarbonate HD. We used 2 type of HF membrane: cellulose diacetate (CDA) and polysulphone (PS). A blood sample for beta 2M was drown before HD, 20 minute after start of HD (for clearance beta 2M) and after HD. RESULTS: Average plasma beta 2M concentration was 53.15 mg/L (27-fold increase than normal values). Post/pre beta 2M ratio was 0.73 with clearance of 23.1 +/- 8.9 ml/min (QB = 250 ml/min, QD = 600 ml/min) for CDA dialyzers, and post/pre beta 2M ratio 0.51 with clearance of 31.9 +/- 4.5 ml/min(QB = 250 ml/min, QD = 600 ml/min) for PS dialyzer, respectively. The CDA membrane was able to remove 103 +/- 29 mg of beta 2M during a 4-hours HD session, and PS membrane 139 +/- 5,1 mg, respectively. CONCLUSION: The only HF membranes are efficient on beta 2M removal.

[A high prevalence of hepatitis C in hemodialysis]. / Visoka prevalenca hepatitisa C na hemodijalizi.

BACKGROUND: Dialysis patients are among groups at risk for development of Hepatitis C infection. Most studies show a significant correlation between anti-HCV seropositivity and the number of blood transfusions and duration of dialysis. Transmission of HCV by transfusions has become rare since the introduction of antibody screening. However nosocomial transmission of HCV within dialysis units increase. The aim of the study was to evaluate the prevalence and the incidence of seroconversion for HCV in our HD unit during the period from January 1997 to 2000. METHODS: We studied 133 pts (59 females) mean age 50.2 + 14 with mean dialysis duration of 35 months, from the beginning of 1997 to January 2000. 71 pts were seronegative and 62 seropositive for anti-HCV antibodies. The seroprevalence of confirmed anti-HCV patients increased from 46.51% (1997 yrs) to 49.06% (1998) and dropped in 1999 (46.62%). RESULTS: The yearly seroconversion rate ranged from 11.52% (1998) to 7.52% (1999). Till the end of 1998 all patients shared same machines, and from 1999 we had 3 separate machines for only negative patients. Our results showed that duration of dialysis is risk factor for development HCV infection (p < 0.01) seropositive 5.215 + 3.9 years, seronegative 2.2 + 1.55, as also multiple blood transfusions > 5 units. CONCLUSIONS: Our results confirmed previous investigations that duration of HD and blood products are risk factor for HCV infection. High incidence seropositivity by our patients suggested nosocomial transmission of HCV, and was needed implementation of universal precautions in HD units.

[Changes in lymphocyte receptors and their activation markers during hemodialysis using various membranes]. / Promjene limfocitnih receptora i njihovih aktivirajucih markera tokom hemodijaliznog tretmana na razlicitim membranama.

BACKGROUND: It's known that uremia is accompanying with different alteration of immune system. Also, different type of dialysis membranes can affect the immunological competence cells--lymphocytes and their function during hemodialysis (HD). AIM OF STUDY: To establish the effect of single hemodialysis session with polysulfonic and cellulose--acetat membranes on lymphocyte subpopulations and their activation markers. METHODS: In two groups of seven patients with end stage of renal disease (ESRD) on periodic HD we were investigated flow-cytometrical expression the following markers using monoclonal antibodies (BECTON DICKENSON): CD3 (T-Ly), CD19 (B-Ly), CD4 (T helper/inducer), CD8 (T-suppressor/cytotoxic), CD4/CD8 ratio, CD16 (NK cells), CD3/HLA-DR (late activated T-cells), CD4/CD 25 (IL-2R early activated T4), CD4/HLA-DR (late activated T8), CD8/CD25 (early activated T8), CD8/CD71 (late activated CD8). Blood samples were taken before HD, 30 minutes into HD and at the end of a four-hours HD session. RESULTS: Demostrates statistical increased expression T helper cells on both membranes on minute 30 from beginning of HD procedure, but more on cellulose-acetat membranes and the significant falls to normal value at the end of HD: start 46.7% minute 30: 54.9%, minute 240: 42.7%. Significant changes were in expression of NK cells on cellulose-acetat membranes: start 12.7%; minute 30: 6.0; minute 240: 11.1%. No changes were noted in activations of T Ly, T4 and T8 on the both membranes. CONCLUSION: No significant difference was found in expression of lymphocyte subpopulations and their activations during HD with polysulfone membranes. Significant changes of the expression of NK cells during HD with cellulose acetat, indicated that NK cells can be sensitive marker for biocompatibility of HD membranes.

[Echocardiographic changes in patients with chronic renal insufficiency on hemodialysis]. / Ehokardiografske promjene kod pacijenata sa hronicnom bubreznom insuficijencijom na hemodijalizi.

Cardiovascular diseases cause death in 40% patients on the chronic haemodialysis program. Our aim was to assess the heart changes in these patients by echocardiography. We have tested 40 patients, but 34 of them accomplished criteria for this study. There were 19 (55.88%) females and 15 (44.12%) males. The average age was 44 years and average duration of haemodialysis treatment was 4.72 years. The research was made with ultrasound device TOSHIBA SSH 65 A SONOLAYER and transducers 3.5 and 2.75 MHz. Twenty patients (58.82%) have had pathological echocardiogram. Ten patients (29.42%) have had conditionally normal echocardiogram while four patients (11.76%) have had completely normal echocardiogram. In patients with pathological echocardiogram, some of the left ventricle hypertrophy forms dominated. Echocardiography is a useful method in morphologic and functional cardiac assessment at the last stage renal disease patients on the chronic haemodialysis program. Using the aforementioned method we are able to select the patients who need intensive cardiac care.

[Structure of chronic dialysis patients in Bosnia-Herzegovina--a multicenter study]. / Struktura hronicnih dijaliznih bolesnika u BiH--multicentricna studija.

INTRODUCTION: In BiH there are no summary data about chronic dialysis patients (CDP). With this study we tray to make first step to establish B&H system for collecting necessary data. METHODS: This is a retrospective study for 1999 years. We collect data with question form which have been distributed to dialysis centers (DC) in BiH. RESULTS: We got answer from 6 (37.5%) DC: Tuzla, Sarajevo, Bihac, Odzak, Travnik and Tesanj. Totally number of CDP was 533, 256 female (48%) and 277 male (52%), and 79% of them are between 26-65 yrs. Leading primary renal diseases were: glomerulonephritis 22%, pyelonephritis 16%, endemic nephropathy 11%, unknown ESRD 10%, polycystic renal disease 9% and diabetes 9%. Peritoneal dialysis have ben performed in 10 patients only, and bicarbonat HD in 46% of CDP. Half of the patients had serum haemoglobin lower than 7 mmol/1 and only 12% received erythropoietin. 17% of the patients had coronary disease, and 7% peripheral vascular disease. We registered 43 (8%) HBsAg, but 294 (55%) antiHCV positive patients. 52% of the CDP have been vaccinated against B hepatitis. Last year died 76 patients (14.26%), mostly caused by coronary diseases (21%), cardial failure (20%), cerebrovascular accidents (15%) and sepsis (11%). 53% of patients are on dialysis between 1-5 yrs. CONCLUSION: In this study participated 6 DC only, but we think that data we collect are good basis for establishing B&H system for registration and follow-up of the ESRD patients.