It is very important to have a surveillance system for early diagnosis of HCV infection in dialysis centers and for control of it we should attend to some strategies, such as:
1. Less transfusion, more use of erytropoithin.
2. More education for the nurses in dialysis centers.
3. Treatment of HCV infected patients.
Do you agree with dedication of HCV infected from non-infected patients in dialysis centers?
Article Epidemiology and risk factors of HCV infection among hemodia...
In California, a hepatitis panel is done on all patients starting dialysis. Patients that have hepatitis B, hepatitis C and HIV are put in a separate "isolation" area of the room and the machines are bleached after being used in addition to the usual vinegar and heat disinfection. Testing is repeated yearly to check for cross contamination as required by the state. Procrit (erythropoietin) is used on a routine basis. Routine blood work (including CBC and chemistry) is done monthly and the Procrit dosis is adjusted as needed by the nephrologist. In addition to that, because Procrit has a black box warning, patients must be educated about the possible risks of using Procrit and they have to sign a paper that says they were notified. Patients and staff are given vaccines for Hepatitis B, pneumonia and flu and the staff has a yearly Hep B titer done to make sure they have enough immunity.
Quality of dialysis centers is judged by the SMART scale which includes monitoring the % of patients that have a hemoglobin above and below target range. Here's an example. This center was rated as having 4% of patients with a hemoglobin below target and 2% above target. http://dialysis-centers.findthebest.com/l/425/Kidney-Institute-of-The-Desert
Treatment of HCV in dialysis patients is difficult because they are anemic to begin with so using ribavirin is usually contraindicated. If ribavirin is used then you can expect that the patients will need multiple transfusions. Besides that, dialysis patients who have Hepatitis C may not need treatment because their viral load is lowered on the days they have dialysis which may allow their HCV to be stable.
I strongly agree with this statement, but let me underscore that HCV infected patients are to be considered only those with HCV-RNA detectable. Indeed a lot of my patients have HCV antibody with undetectable RNA and I think no isolation is required
i agree with Marco;usually I consider patients without rna detectable like negative patients. I think that it's important to give them a lot of clinical attention because they have enhanced risk of neoplasm,lymphoma,ecc..
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