Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
- - Patients transferred to another dialysis center during the study period;
- - Transient dialysis patients (temporarily residing in the district due to travel, family visits, etc.);
- - Patients with an acute medical indication requiring hemodialysis treatment;
- - Patients undergoing peritoneal dialysis at home (they are not exposed to the same procedures and conditions as in the hemodialysis center).
2.2. Algorithm for Examining Patients
- Familiarizing the patients with the purpose of the study and filling out an informed consent form. The collection of blood samples (5 mL of venous blood each) was conducted after the submission of informed consent.
- Blood samples were immediately centrifuged (at 2000 rpm), and the serum was separated into two aliquots (one for anti-HEV antibodies detection and the second for HEV RNA detection) and stored at −80 °C until use.
- Initially, all serum samples were tested for the presence of specific HEV antibodies (anti-HEV IgM and anti-HEV IgG).
- Secondly, regardless of antibody results, all patients were tested for the presence of HEV RNA. According to the recommendations of the EASL (European Association for the Study of the Liver) [12], for the diagnosis of HEV infection (acute and chronic) in immunocompromised persons, it is recommended that serology and Nucleic Acid Amplification Testing (NAT) be used in combination, as a negative NAT does not exclude acute infection and serology is sometimes negative in immunosuppressed patients with chronic infection.
- All specimens were negative for HEV RNA. Therefore, for the purpose of analysis, the samples were divided into two groups based on the presence of HEV antibodies: (1) HEV IgG seroprevalence (anti-HEV IgG alone); (2) and overall HEV seroprevalence, based on all positive samples regardless of the type of HEV antibody marker (anti-HEV IgM and/or anti-HEV IgG).
- An additional examination for the presence of HBV (HBsAg) and HCV (anti-HCV) coinfection was performed.
2.2.1. Serological Testing
2.2.2. Quantification of the HEV RNA
2.3. Statistical Analysis
2.4. Ethical Statement
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Hemodialysis Patients (n = 225) |
---|---|
Age (year) | |
Median | 64 |
25th; 75th percentile | 52.5; 71.5 |
Min–max | 24–95 |
Age decades, n (%) | |
18–49 | 44 (19.6) |
50–59 | 43 (19.1) |
60–69 | 61 (27.1) |
≥70 | 77 (34.2) |
Gender, n (%) | |
Male | 126 (56.0) |
Female | 99 (44.0) |
M:F | 1.3:1 |
Place of residence, n (%) | |
Town | 153 (68.0) |
Village | 72 (32.0) |
Duration of hemodialysis (months) | |
Median (25th percentile; 75th percentile) | 48 (24; 72) |
Duration of dialysis, n (%) | |
≤1 year | 60 (26.7) |
2–5 years | 91 (40.4) |
>5 years | 74 (32.9) |
Vascular access, n (%) | |
AV fistula | 121 (53.8) |
Permanent catheter | 99 (44.0) |
Vascular prosthesis | 5 (2.2) |
Previous kidney transplantation, n (%) | |
Yes | 9 (4.0) |
No | 216 (96.0) |
Blood transfusion, n (%) | |
Yes | 132 (58.7) |
No | 93 (41.3) |
History of surgical intervention, n (%) | |
Yes | 159 (70.7) |
No | 66 (29.3) |
Diseases that led to hemodialysis, n (%) | |
Autosomal dominant polycystic kidney disease | 34 (15.2) |
Chronic tubulointerstitial nephritis | 34 (15.2) |
Chronic glomerulonephritis | 33 (14.7) |
Chronic calculous pyelonephritis | 25 (11.1) |
Diabetic nephropathy | 21 (9.3) |
Hypertensive kidney disease | 18 (8.0) |
Bilateral hydronephrosis | 10 (4.4) |
Chronic nephritic syndrome | 10 (4.4) |
Other disease | 40 (17.7) |
Kidney disease in other family member, n (%) | |
Yes | 50 (22.2) |
No | 175 (77.8) |
Hepatitis (jaundice) in the past *, n (%) | |
Yes | 22 (9.8) |
No | 203 (90.2) |
Comorbidities **, n (%) | |
Arterial hypertension | 151 (67.1) |
Secondary anemia | 132 (58.7) |
Ischemic heart disease | 43 (19.1) |
Heart failure | 29 (12.9) |
Diabetes | 27 (12.0) |
Nephrectomy | 12 (5.3) |
Oncological diseases | 10 (4.4) |
Liver cirrhosis | 3 (1.3) |
Traveled abroad in the last 3 months, n (%) | |
Yes | 1 (0.4) |
No | 224 (99.6) |
Variable | Center 1 (n = 80), % | Center 2 (n = 112), % | Center 3 (n = 33), % | p-Value |
Overall HEV seroprevalence *, (n = 24) | 7 (8.8%) | 14 (12.5%) | 3 (9.1%) | 0.645 |
HEV IgG seroprevalence (n = 14) | 4 (5%) | 10 (8.9%) | 0 (0%) | 0.150 |
HBsAg (+), n (%) | 5 (6.3%) | 4 (3.6%) | 4 (12.1%) | 0.195 |
anti-HCV (+), n (%) | 5 (6.3%) | 8 (7.1%) | 2 (6.1%) | 0.937 |
Parameters | HEV IgG Seroprevalence (n = 14) n (%) | HEV Markers (−) (n = 201) n (%) | p-Value | Overall HEV Seroprevalence (n = 24) n (%) | HEV Markers (−) (n = 201) n (%) | p-Value |
---|---|---|---|---|---|---|
Age decades | 0.473 | 0.462 | ||||
18–49 | 2 (14.3) | 41 (20.4) | 3 (12.5) | 41 (20.4) | ||
50–59 | 1 (7.1) | 40 (19.9) | 3 (12.5) | 40 (19.9) | ||
60–69 | 4 (28.6) | 54 (26.9) | 7 (29.2) | 54 (26.9) | ||
≥70 | 7 (50.0) | 66 (32.8) | 66 (32.8) | |||
Gender | 0.918 | 0.808 | ||||
Male | 8 (57.1) | 112 (55.7) | 14 (58.3) | 112 (55.7) | ||
Female | 6 (42.9) | 89 (44.3) | 10 (41.7) | 89 (44.3) | ||
Place of residence | 0.770 | 0.753 | ||||
Town | 10 (71.4) | 136 (67.7) | 17 (70.8) | 136 (67.7) | ||
Village | 4 (28.6) | 65 (32.3) | 7 (29.2) | 65 (32.3) | ||
Hemodialysis duration (yrs.) | 0.522 | 0.306 | ||||
≤1 year | 2 (14.2) | 56 (27.9) | 4 (16.7) | 56 (27.9) | ||
2–5 years | 6 (42.9) | 78 (38.8) | 13 (54.2) | 78 (38.8) | ||
>5 years | 6 (42.9) | 67 (33.3) | 7 (29.2) | 67 (33.3) | ||
Vascular access (Yes) | 0.007 | 0.275 | ||||
AV fistula | 2 (14.3) | 111 (55.2) | 10 (41.7) | 111 (55.2) | ||
Permanent catheter | 12 (85.7) | 85 (42.3) | 14 (58.3) | 85 (42.3) | ||
Vascular prosthesis | 0 (0) | 5 (2.5) | 0 (0) | 5 (2.5) | ||
Predictor variables | ||||||
Blood transfusion | 0.938 | 0.687 | ||||
Yes | 8 (57.1) | 117 (58.2) | 15 (62.5) | 117 (58.2) | ||
No | 6 (42.9) | 84 (41.8) | 9 (37.5) | 84 (41.8) | ||
Surgical intervention | 0.458 | 0.149 | ||||
Yes | 11 (78.6) | 139 (69.2) | 20 (83.3) | 139 (69.2) | ||
No | 3 (21.4) | 62 (30.8) | 4 (16.7) | 62 (30.8) | ||
Hepatitis infection in the past | 0.203 | 0.327 | ||||
Yes | 0 (0) | 21 (10.4) | 1 (4.2) | 21 (10.4) | ||
No | 14 (100) | 180 (89.6) | 23 (95.8) | 180 (89.6) | ||
Food consumption | ||||||
Pork | 0.840 | 0.559 | ||||
Yes | 12(85.7) | 176 (87.6) | 22 (91.7) | 176 (87.6) | ||
No | 2 (14.3) | 25 (12.4) | 2 (8.3) | 25 (12.4) | ||
Fish | 0.226 | 0.054 | ||||
Yes | 13 (92.9) | 160 (79.6) | 23 (95.8) | 160 (79.6) | ||
No | 1 (7.1) | 41 (20.4) | 1 (4.2) | 41 (20.4) | ||
Vegetable leafy greens | 0.885 | 0.519 | ||||
Yes | 12 (85.7) | 175 (87.1) | 22 (91.7) | 175 (87.1) | ||
No | 2 (14.3) | 26 (12.9) | 2 (8.3) | 26 (12.9) | ||
Water intake | ||||||
Tap water | 0.548 | 0.687 | ||||
Yes | 7 (50.0) | 117 (58.2) | 15 (62.5) | 117 (58.2) | ||
No | 7 (50.0) | 84 (41.8) | 9 (37.5) | 84 (41.8) | ||
Bottled water | 0.268 | 0.975 | ||||
Yes | 8 (57.1) | 143 (71.1) | 17 (70.8) | 143 (71.1) | ||
No | 6 (42.9) | 58 (28.9) | 7 (29.2) | 58 (28.9) | ||
Private water source | 0.127 | 0.162 | ||||
Yes | 0 (0) | 29 (14.4) | 1 (4.2) | 29 (14.4) | ||
No | 14 (100) | 172 (85.6) | 23 (95.8) | 172 (85.6) | ||
Contact with animals | 0.714 | 1.000 | ||||
Yes | 4 (28.6) | 67 (33.3) | 8 (33.3) | 67 (33.3) | ||
No | 10 (71.4) | 134 (66.7) | 16 (66.7) | 134 (66.7) | ||
HBsAg | 0.792 | 0.570 | ||||
Yes | 1 (7.1) | 11 (5.5) | 2 (8.3) | 11 (5.5) | ||
No | 13 (92.9) | 190 (94.5) | 22 (91.7) | 190 (94.5) | ||
anti-HCV | 0.980 | 0.603 | ||||
Yes | 1 (7.1) | 14 (7.0) | 1 (4.2) | 14 (7.0) | ||
No | 13 (92.9) | 187 (93) | 23 (95.8) | 187 (93.0) |
Model | Unstandardized Coefficients | Wald | df | Sig. | Exp(B) | 95% Confidence Interval for B | ||
---|---|---|---|---|---|---|---|---|
B | Std. Error | Lower Bound | Upper Bound | |||||
(Constant) | −4.16 | 1.97 | 4.42 | 1 | 0.036 | 0.02 | ||
Age groups | ||||||||
18–49 yrs. (baseline) | ||||||||
50–59 yrs. | −1.92 | 1.36 | 1.98 | 1 | 0.159 | 0.15 | 0.01 | 2.12 |
60–69 yrs. | −0.28 | 1.01 | 0.08 | 1 | 0.785 | 0.76 | 0.11 | 5.48 |
≥70 yrs. | −0.18 | 0.95 | 0.04 | 1 | 0.852 | 0.84 | 0.13 | 5.41 |
Hemodialysis duration | ||||||||
≤1 yr. (baseline) | ||||||||
2–5 yrs. | 0.92 | 0.94 | 0.97 | 1 | 0.325 | 2.52 | 0.40 | 15.91 |
>5 yrs. | 1.90 | 0.97 | 3.84 | 1 | 0.049 | 6.67 | 1.01 | 44.37 |
Vascular access | ||||||||
AV fistula (baseline) | ||||||||
Vein prosthesis | −16.35 | 16 574.32 | 0.00 | 1 | 0.999 | 0.00 | 0.00 | 0.00 |
Permanent central vein catheter | 2.54 | 0.88 | 8.38 | 1 | 0.004 | 12.72 | 2.27 | 71.20 |
Blood transfusion | ||||||||
No (baseline) | ||||||||
Yes | −0.69 | 0.68 | 1.02 | 1 | 0.31 | 0.50 | 0.13 | 1.92 |
Surgical intervention | ||||||||
No (baseline) | ||||||||
Yes | 0.89 | 0.82 | 1.17 | 1 | 0.280 | 2.43 | 0.49 | 12.12 |
Food habits—consumption of pork | ||||||||
No (baseline) | ||||||||
Yes | −0.49 | 0.95 | 0.26 | 1 | 0.608 | 0.61 | 0.10 | 3.96 |
Food habits—consumption of fish | ||||||||
No (baseline) | ||||||||
Yes | 1.06 | 1.17 | 0.82 | 1 | 0.366 | 2.88 | 0.29 | 28.54 |
Type of drinking water intake—tap water | ||||||||
No (baseline) | ||||||||
Yes | −1.25 | 0.85 | 2.16 | 1 | 0.142 | 0.29 | .05 | 1.52 |
Type of drinking water intake—bottled water | ||||||||
No (baseline) | ||||||||
Yes | −1.69 | 0.85 | 3.91 | 1 | 0.048 | 0.19 | 0.04 | 0.99 |
Animal contact | ||||||||
No (baseline) | ||||||||
Yes | −0.37 | 0.78 | 0.23 | 1 | 0.635 | 0.69 | 0.15 | 3.17 |
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Kevorkyan, A.; Golkocheva-Markova, E.; Raycheva, R.; Rangelova, V.; Komitova, R.; Atanasova, M.; Tzekov, V.; Kostadinova, T.; Chardakova, T. Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria. Pathogens 2023, 12, 1208. https://doi.org/10.3390/pathogens12101208
Kevorkyan A, Golkocheva-Markova E, Raycheva R, Rangelova V, Komitova R, Atanasova M, Tzekov V, Kostadinova T, Chardakova T. Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria. Pathogens. 2023; 12(10):1208. https://doi.org/10.3390/pathogens12101208
Chicago/Turabian StyleKevorkyan, Ani, Elitsa Golkocheva-Markova, Ralitsa Raycheva, Vanya Rangelova, Radka Komitova, Mariya Atanasova, Valeri Tzekov, Tanya Kostadinova, and Tsvetelina Chardakova. 2023. "Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria" Pathogens 12, no. 10: 1208. https://doi.org/10.3390/pathogens12101208
APA StyleKevorkyan, A., Golkocheva-Markova, E., Raycheva, R., Rangelova, V., Komitova, R., Atanasova, M., Tzekov, V., Kostadinova, T., & Chardakova, T. (2023). Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria. Pathogens, 12(10), 1208. https://doi.org/10.3390/pathogens12101208