Kidney failure interferes with the ability of the body to fight infections therefore making it easier to acquire infections. In addition, kidney patients may need to undergo important and life saving treatments such as dialysis catheter placement, blood transfusion or dialysis treatment and during such treatments, patients are at risk of acquiring a number of infections.
An important challenge in the care of patients with kidney disease and especially those on dialysis is the prevention and management of infections. The more common infections important to dialysis patients for instance involve infections of the dialysis access such as the dialysis catheter, graft or fistula. However, viral infections involving the HIV, Hepatitis B and Hepatitis C viruses are also quite important as they can cause serious medical problems.
The first steps to understanding the risk of viral infection in Nigeria and protecting oneself is to know the risk of blood transfusion related and dialysis procedure related infections in Nigeria.
In a study from a major teaching hospital in mid western Nigeria, the risk of blood transfusion related syphilis infection was estimated at about 384 cases per year1. In another study from western Nigeria, the estimated prevalence of Hepatitis B, HIV, Hepatitis C and syphilis was found to be 18.6%, 3.1%, 6% and 1.1% respectively2 meaning that if 5000 transfusions were provided from such a blood pool in a year, approximately 900 cases of blood transfusion related Hepatitis B, 150 cases of HIV, 300 cases of Hepatitis C and 50 cases of syphilis could have been potentially created. In northern, south western and eastern Nigeria, the situation is just as concerning where the prevalence of donors with such infections is just as high3-9. Depending on the age of the donor, the risk of these infections could be even higher as the prevalence of infected donors that look healthy could be as high as 60%9.
It is however important to understand the main reasons for the high prevalence of such infections among persons donating blood:
Window Period for Testing
The platform for all currently available blood donor screening testing in Nigeria and most other countries is not based on detection of the actual virus but based on the detection of antibody against the virus in the blood of the possible donor. Antibody is a substance produced by the body to fight infection and sometimes might be able to cure the infection and sometimes it cant. Depending on the infection in question, there is an incubation period during which the person could infect others with live virus without yet producing antibody in their blood to the organism they are infected with. This period during which they are infectious, without symptoms of disease and without antibody in their blood that can be picked up by these antibody based tests is called the “window period”. For HIV, the window period is 3-6 months, for hepatitis B and C it is about 1-3 months.
Paid Blood Donors vs Family Blood Donors
It is estimated that well over 90% of all blood donors in Nigeria are paid or commercial blood donors that receive compensation for their donation as opposed to non-commercial voluntary blood donors such as family members who are not paid. Paid donors are less likely to be truthful about their medical history and risk and still donate blood while knowing they may be infected. However, the medical status of family members is usually know and family or volunteer donors who are unpaid are much less likely to donate when they know they may have a transmissible infection.
Inadequate Blood Testing
Because of the high demand for blood, many private establishments may not have the appropriately trained staff to screen blood properly. There may also be expired or fake viral testing kits as well as the temptation by hospitals to accept infected blood and proceed to sell the blood as uninfected blood.
The seriousness of the infections in Nigeria is reflected in the high number of people newly infected with these viruses or already living with these infections.
Hemodialysis patients are at high risk for infection because the process of hemodialysis requires access to the blood for prolonged periods. In an environment where many patients receive dialysis at the same time, repeated opportunities exist for person-to-person transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, shared medications or hands of personnel.
The risk of dialysis related viral infection transmission has not been studied systematically in Nigeria. The only information available on the risk of transmission of such infections by dialysis treatment itself comes from studies performed in other countries. For instance in 1993 before the application of stringent prevention strategies, in Egypt and Columbia, there was an outbreak of HIV due to currently unacceptable dialysis practices10-11. With these observations, a number of safeguards were recommended by a number of professional bodies to reduce the transmission of such infections. In the US where there is very strict monitoring of such infections and application of processes to reduce the risk of infection transmission, the risk of dialysis treatment related infection is as low as 1%.
Solutions to the problem of viral infections in kidney disease and dialysis patients:
1. Avoid unnecessary blood transfusion. Ask your doctor how you might be able to avoid transfusion if possible. There are medicines that have been available for up to 30 years that can help avoid blood transfusion. To learn more about treatment of low blood levels such as anemia in patients with kidney disease, click here.
2. If you must get a blood transfusion, please ensure the supply is safe. Get a healthy family member to donate for you.
3. Medical centers need to sterilize dialysis machines and other durable equipment in between treatments.
4. There should be single patient use of consumables and medications given during dialysis – all consumables should be used on one patient only. Do not allow a nurse or doctor use any needles, guide wires or equipment that touches blood on you if they have been used on someone else already.
5. Observation of universal precautions in interactions between staff and patients. Hand-washing and changing gloves is important.
6. Repeat screening and testing for these viruses every couple of months. It might seem like a waste of money but especially if you are a dialysis patient. If you do become infected at some point, finding out early will be of benefit to direct proper and timely treatment.
7. Vaccination of dialysis patients and staff against hepatitis B. Ask you kidney or dialysis doctor to give you a hepatitis B vaccine if you have never received one. Unfortunately, there is no vaccine for HIV or Hepatitis C yet.
To learn more about the work we do with patients with Kidney disease visit us at www.kidney-solutions.com
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