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The scourge of cross infections in the dialysis unit

Posted Jul 13 2010 6:42pm
(Cross posted from http://dialysis.org.in )

A third of people who are on maintenance hemodialysis eventually get infected with a chronic viral disease. Isn't this shocking?

The disease is usually Hepatitis C. Some people also get infected with Hepatitis B or HIV. Hepatitis C is a disease that affects the liver. 85% of people with Hepatitis C proceed to liver cirrhosis necessitating a liver transplant. As if losing your kidneys was not enough!

What is the primary reason behind this?

There is only one. Human error. Yes. Human error. A person who is already suffering with a chronic condition, who is dialysis dependent is handed another sentence. Simply due to the carelessness of an individual. This is so horrible. And the attitude of most professionals towards this in the dialysis industry is so callous that it can be only described as criminal. They simply do not realize, and for the most part, neither do many patients, what is happening here.

Once a dialyzor is infected with a virus such as Hepatitis C, there are more hurdles for a transplant. Most centers will prefer giving a kidney to a person who is negative (virus free) rather than someone who is positive. Even assuming that the person gets a kidney, the whole treatment after a transplant becomes all the more complex because the doctors have to keep in mind that the immunosuppression drugs can cause a flare up of the Hepatitis C virus causing further damage to the liver. Every decision needs to be taken keeping this in mind.

There are treatments available for Hepatitis C but the chances of success (eliminating the virus) are still quite low. Especially when you're on dialysis. This is because the virus is best treated with a combination of two drugs - pegylated interferon and ribavirin. The first actually reduces the viral load (number of virus copies per ml of blood) but the second actually helps keep it down. Ribavirin, however, causes severe anemia in people on dialysis. So, people on dialysis are treated only with pegylated interferon. This further reduces the chances of successfully treating the disease in the dialysis population.

(I am not trying to paint a dismal picture here. There are many people on dialysis who are successfully treated for Hepatitis C. So, if you're on dialysis and are positive, definitely consider treating it.)

The only point I am trying to make is that due to human error, many lives are being further spoilt. This is something that can easily be avoided. Units must follow stringent processes. There are a set of published guidelines by the Center for Disease Control that lay down the procedures to be followed and the precautions to take to prevent cross infections in dialysis units. All centers must actively follow these guidelines.

The problem with this infection is that you will know you have been infected only after a few weeks (sometimes months). So, no one can nail down why the infection happened and how. You can only guess. The disease itself is indolent. You don't see symptoms until many years. So, medical professionals take this fairly lightly. In young people, however, this is a really serious problem. Being diagnosed with kidney disease itself at a young age can be quite shattering. Having this additional cross to bear is totally unfair.
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