THE RELATIONSHIP BETWEEN DURATION OF DIALYSIS AND HISTORY OF BLOOD TRANSFUSION WITH HEPATITIS C SEROPREVALENCE IN HEMODIALYSIS PATIENTS: A CROSS-SECTIONAL STUDY AT GADJAH MADA UNIVERSITY ACADEMIC HOSPITAL

Background: Hepatitis C Virus (HCV) is an RNA virus that causes hepatitis C disease. Hemodialysis patients are a group at high risk of becoming infected with the HCV. Based on prior research, the duration of hemodialysis has been identified as an independent risk factor for HCV. Risk factors for HCV transmission in hemodialysis patients can also include blood transfusions. Purpose: This research aimed to determine the relationship between the duration of dialysis and the history of blood transfusion with HCV seroprevalence in hemodialysis patients at Gadjah Mada University Academic Hospital. Method: This research utilized a cross-sectional research design. The research data were based on secondary data from the medical records of hemodialysis patients at Gadjah Mada University Academic Hospital. Result: The results were analyzed descriptively and statistically using the Chi-square test with significance (α = 0.05). Data obtained from this research showed that the HCV seroprevalence of hemodialysis patients at Gadjah Mada University Academic Hospital is 20.5%. The test results revealed a relationship between duration of dialysis with HCV seroprevalence in hemodialysis patients is a p-value = 0.021 (p-value < α), and a relationship between history of blood transfusion with HCV seroprevalence in hemodialysis patients is a p-value = 0.024 (p-value < α). Conclusion: The results of the Chi-square test showed a relationship between duration of dialysis and history of blood transfusion with HCV seroprevalence in hemodialysis patients at Gadjah Mada University Academic Hospital.

Introduction

Hepatitis C Virus (HCV) is an RNA virus that causes hepatitis C disease. HCV that enters the body will trigger antibodies to HCV. HCV antibodies (anti-HCV) can be measured through a serological examination (Deniz and Akhan, 2023(Deniz & Akhan, 2023)). HCV initially causes no symptoms and later develops into a chronic form, causing liver cirrhosis and liver cancer. An acute infection can result in severe liver damage and in rare cases, even lead to death (Niepmann and Gerresheim, 2020(Niepmann & Gerresheim, 2020)). Hemodialysis patients are a group at high risk of being infected with HCV. Hemodialysis is an invasive procedure that carries a risk of infection. Dialysis procedures, blood contamination on device surfaces, and the presence of a large number of patients undergoing dialysis in shared spaces are the causes of these risk factors. Hemodialysis patients infected with HCV can become carriers and have the potential to spread the virus in the hemodialysis environment. HCV infection within dialysis units suggests a nosocomial infection with various risk factors related to the dialysis procedure. The duration of hemodialysis was found to be an independent risk factor for HCV (Dharmesti et al., 2022(Dharmesti et al., 2022)). The incidence of hepatitis C in hemodialysis patients is much higher than in healthy subjects (Morishita et al., 2019(Morishita et al., 2019)).

According to the Global Hepatitis Report, people have chronic HCV infection an estimated 58 million with about 1.5 million new infections occurring per year (WHO, 2023(Organization, 2023)). The prevalence of HCV in Indonesia is based on study data from the National Basic Health Research in 2014, which shows the prevalence of anti-HCV positive by 0.8 - 1% in Indonesia (Ministry of Health, 2019(Health, 2019)). HCV infection is asymptomatic in its earliest stages, but up to 30% of cases progress to cirrhosis within 10 to 30 years. The probability rate of complications of liver cirrhosis to hepatocellular carcinoma associated with HCV infection is about 1 to 4% every year (Bohorquez et al., 2023(Bohorquez et al., 2023)). The World Health Organization (WHO) estimated that 1 in 3 people in the world have been infected by either Hepatitis B Virus (HBV) or HCV, and 1.3 million people died as a result of this disease in 2015. It has been reported that approximately 185 million of those people are infected with HCV (Jefferies et al., 2018(Jefferies et al., 2018)). Chronic HCV infection is a global health burden with an estimated prevalence varying between 0.6% – 10% (Modin et al., 2019(Modin et al., 2019)). On the seroprevalence for HCV in blood donors at UTD PMI Semarang Java Middle in 2019, the percentage of HCV reactive blood was 0.2%, namely 183 bags out of 83.074 bags (Adhyatma et al., 2020(Adhyatma et al., 2020)). According to a study by Novayanti and Loesnihari(Novayanti & Loesnihari, 2019)(2019), the prevalence of patients with positive anti-HCV undergoing hemodialysis was 120 patients (93.7%) out of 128 patients.

Nosocomial transmission in hemodialysis patients infected with HCV can be caused by poor hygiene of dialysis equipment. The risk factor for transmission of hepatitis infection through hemodialysis is estimated at around 10% per year. Blood transfusions can also be a risk factor for HCV transmission in hemodialysis patients, who serve as a significant medium in the transmission of HCV infection. Most cases of hepatitis infection occur after blood transfusions. About 1 per 100.000 or 0.001% of units of blood used for transfusion are at risk of HCV contamination. The average prevalence rate of HCV infection in patients who receive packed red cell or plasma transfusions is around 19% (Alhawaris, 2019(Alhawaris, 2019)). Transmission of HCV also occurs through contact with the blood or body fluids of an infected person (Mustika and Simatupang, 2020(Mustika & Simatupang, 2020)).

Research on the relationship between risk factors for duration of dialysis and history of blood transfusion with HCV seroprevalence in hemodialysis patients at the Gadjah Mada University Academic Hospital (RSA UGM) has never been conducted. Patients with an anti-HCV reactive at the RSA UGM are not isolated and do not use special machines. Hemodialysis patients with reactive anti-HCV can use a re-dialyzer. The sterilization room for repeat dialyzer used in hemodialysis patients with reactive anti-HCV and non-reactive anti-HCV is a single room, with a separate washing area. The incidence of chronic kidney failure patients undergoing hemodialysis with hepatitis C seropositivity is an indicator of the quality of the hemodialysis unit at the RSA UGM. This research aimed to determine the seroprevalence of HCV antibodies in hemodialysis patients at the RSA UGM. The purpose of this research was also to determine the relationship between risk factors for the duration of dialysis and the history of blood transfusion with seroprevalence for HCV in hemodialysis patients at the RSA UGM.

Material and Method

The data collected were analyzed through univariate and bivariate analyses. The statistical test used for this research was chi-square with a 95% confidence level. This research has been registered and obtained a research ethics permit from the Health Research Ethics Commission, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University – Dr Sardjito General Hospital with registration number Ref. No.: KE/FK/0707/EC/2020 and date of approval June 30^th, 2020.

The type of research used was a cross-sectional study based on secondary data from medical records of