Kazuo Yokozeki

Hepatitis C infection unrelated to blood transfusion in hemodialysis patients

Hepatitis C virus antibodies were studied using both the 1st and 2nd generation tests in 485 patients who were on maintenance hemodialysis. One hundred and eighty-seven tested positive for antibodies (38.6%); 139 of them had a history of past blood transfusion. There was a crude correlation between the amount of blood given and the antibody positivity rate among those who had a history of blood transfusion. Of 152 patients who had no blood transfusion history, 48 or 31.2% were positive for the antibodies. The length of the period during which these patients had undergone dialysis was closely correlated with the positivity rate; 50% of those who had been on dialysis for more than 10 years were positive for anti-HCV. The positivity rate among the new dialysis patients with chronic renal failure as the control was 4.6%. The difference may be accounted for by nosocomial hepatitis C virus infection. It appears that with two new needle holes made along the anastomosed blood vessels two to three times a week, the chances of patient exposure to hepatitis C virus may increase with time.

Interferon treatment for chronic hepatitis C in haemodialysis patients: Suggestions based on a small series

Chronic hepatitis C is endemic among chronic haemodialysis patients. There have been a number of reports on hepatocellular carcinoma developing in such patients in Japan. The present study reports on the treatment of 15 patients who showed elevated ALT levels due to biopsy proven chronic hepatitis C with interferon α‐2a (IFN). The dose schedule was 6 mega units (MU) daily for the first two weeks followed by 3 doses per week for 5.5 months. Side effects were so severe that IFN treatment was discontinued early in one patient, the dosage reduced in 11 and only tolerated in the original schedule by three patients. Excluding one patient who only recently completed the therapy, 13 were able to be evaluated for therapy efficacy by assessment of serum ALT and viral RNA. The overall results showed that IFN was effective in eight of 13 patients, a rate somewhat higher than the reported figures in this country. It is concluded that IFN therapy is indicated in haemodialysis patients with progressive chronic hepatitis C, but the dose administered should be lower and the dose schedule more flexible, perhaps 3 MU three times a week, in order to minimize untoward side effects.

Acute hepatitis C among renal failure patients on chronic haemodialysis

Hepatitis C virus (HCV) infection is common in haemodialysis units, yet little information is available about the clinical feature of acute hepatitis C among renal failure patients. The present study is based on 49 cases of acute hepatitis C seen at a haemodialysis centre where sporadic nosocomial infection was occurring up to June 1993. Liver function tests were done at 4 weekly intervals on all dialysis patients, anti‐HCV antibodies were tested by the C‐100 and second generation tests and serum HCV‐RNA was determined by the branched DNA and Amplicore tests. Diagnosis of acute hepatitis C was made on the basis of an acute rise in alanine aminotransferase (ALT) and seroconversion to positive anti‐HCV antibodies. Clinical presentation of acute hepatitis was generally mild with rare overt jaundice and the diagnosis was possible only from increased ALT, which was generally low. Spontaneous resolution of acute hepatitis within 8 months with clearance of viral RNA occurred in only four cases, 91.8% of patients developing chronic hepatitis. Biopsy in 12 cases with high ALT levels showed mild to moderate inflammatory activities. In conclusion, the clinical presentation of acute hepatitis C is generally mild in chronic haemodialysis patients, but spontaneous resolution is infrequent. A longer follow‐up period is required for defining the long‐term prognosis.

Autonomic nervous system disturbance in patients treated with chronic hemodialysis

慢性血液透析患者の自律神経障害について, 心電図R-R間隔変動係数 (以下CV) を用いて検討を行った. 対象は, 維持透析者275名 (男159名・女116名・平均年齢46.8歳・平均透析期間61.5ヵ月) のうち, 不整脈を認めた12名を除く263名 (HD群) で, 原疾患の内訳は慢性糸球体腎炎204名, 糖尿病性腎症12名, 妊娠腎12名, 嚢胞腎7名, 腎盂炎7名, 腎硬化症6名, その他15名であった. CVは透析前に測定し, 年齢・透析期間・原疾患の影響を検討した. さらに対照として, 健常者78名 (Cont群)・糖尿病者160名 (DM群) のCVを測定し, 年齢別に比較を行った. また透析中の収縮期・拡張期血圧・脈拍数の最大値と最小値の差を変動値とし, 透析終了後の体重とdry weightの差が500g以内でしかも補液を用いなかった3日間の変動値の平均 (各S・D・P) をとり, CVとの関連を検討した. 透析者群のCVの平均は2.2±1.0%で, 加齢とともに低下傾向を認めた. Cont群, DM群においても加齢に伴いCVは低下したが, 同年代で比較するといずれの年代においてもCont群>DM群>HD群の関係が見られた. 透析期間別に見ると, 10年未満の群では加齢とともにCVは低下傾向を認めたが, その傾向は透析期間の短い群ほど顕著であった. しかし年代別では, 透析期間の長短とCVの間に一定の傾向は認めなかった. 原疾患別では, 慢性糸球体腎炎のCVが2.3±1.0%で263名の全平均とほぼ一致した. また糖尿病性腎症では1.2±0.6%, 腎硬化症では1.4±0.4%と全平均に比べ有意に低値を示したが, 両者の平均年齢は逆に高く年齢の影響が大きいと思われる. 一方嚢胞腎では平均年齢が高いにもかかわらず, CVが2.7±1.3%と高値傾向を認めた. 透析中の血圧変動とりわけ低血圧については, 自律神経機能障害の関与を指摘する報告があるが, 今回CVとS・D・Pとの間にはいずれも相関を認めなかった. むしろ補液の必要な日を対象にすれば, 相関の見られた可能性が考えられる.