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Ellis: Dialysis, Infections, and Hepatitis

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By Glenn Ellis

By definition, hemodialysis is pumping a patient’s blood through a filtration device to remove toxins that failing kidneys can no longer handle, and then pumping it back into the body.

Kidney failure life expectancy, like anything depends on many variables, some of which you can control, and others that you cannot control: age, gender, genes, race, diet, lifestyle choices, what caused your condition (etiology), the type of treatment you choose, etc.

It should be noted that I am discussing life expectancy in relationship to kidney failure. This means that the kidneys are now functioning at or below 15 percent – also termed as End-Stage-Kidney-Failure or Stage 5 Kidney Failure. It is important to make this distinction, because the life expectancy severely drops once at this level.

Dialysis treatment – either in a hospital, a dialysis unit or at home – is needed when the kidneys cannot filter wastes from the body sufficiently. Each year, about 37,000 dialysis patients in the United States develop potentially deadly bloodstream infections associated with their treatment, the Centers for Disease Control says.

According to a new CDC emergency health advisory, there have been an increasing number of reports of the transmission of hepatitis C, or HCV, in patients undergoing dialysis. The number of cases appears to be small, but it should be zero, because HCV can only be transmitted through contaminated blood or blood products.

What has to be involved for this to happen? The only blood that the patient should be receiving or exposed to during dialysis is his or her own. So, transmission of the virus can only come from the patient being exposed to the blood of someone who is already infected: in other words, through poor hygiene or inadequate sanitary practices, sloppiness, or improperly sterilized equipment.

The high risk of infections in dialysis patients is due to a number of factors including the close distance of dialysis patients to each other, the fast patient turn-over between dialysis sessions, and health of the person receiving dialysis. The most common form of treatment for end-stage renal disease (ESRD, or kidney failure) is hemodialysis.   If your medical facility does not follow guidelines for infection control in the right way, it is possible to get hepatitis C from doing hemodialysis.

Hepatitis C virus (HCV) remains common in patients undergoing regular dialysis and is an important cause of liver disease in this population both during dialysis and after a kidney transplant.

Hepatitis C is a viral infection that causes inflammation of the liver and can lead to serious liver damage. It spreads through contaminated blood, most often through intravenous drug use. At least 3.2 million Americans are living with chronic hepatitis C infection and most don’t know it. And with the ongoing opioid epidemic, the numbers of hepatitis C-infected donor organs may be growing as well, experts say.

Many dialysis patients have other health conditions and/or a weakened immune system which can increase susceptibility to infections, especially when infection prevention practices are not strictly followed by dialysis staff. These health conditions often result in dialysis patients having frequent admissions to hospitals which expose them to antibiotic therapy and drug-resistant bacteria. In the U.S., hemodialysis patients are several times more likely to be infected with hepatitis C, and in some countries, up to half of dialysis patients are infected.

In the early years of dialysis, there was a danger of getting hepatitis B through exposure to the blood of an infected person at the dialysis unit. However, today the chance of getting hepatitis B through your treatment is very small because of two important advances. One of these advances is the use of strict infection control measures in dialysis units. The second improvement is the availability of a vaccination for hepatitis B.

Between 10 and 30 percent of dialysis patients carry the hepatitis C virus compared to 1 percent of the general population. Most people acquire the virus during blood transfusions, and kidney patients, who sometimes suffer severe anemia, are more likely to have had a transfusion.

Hepatitis C is curable now and we need to take a step back and really see this as an untapped supply of donors that can save hundreds if not thousands of lives.

Although getting hepatitis C in a dialysis center is not very common, doctors recommend dialysis patients get tested regularly. If you are starting hemodialysis, most centers will test you for hepatitis C before your first treatment. You should expect to be tested for hepatitis C about every six to 12 months for as long as you are doing in-center hemodialysis.

If you ever feel concerned about the safety practices in your dialysis center, you can tell a staff member. If you do not want to tell someone at your center, you can contact your state’s ESRD network or State Department of Health to file a grievance (submit a complaint). Never feel afraid to speak up about something you think is not right. It could protect you, and others.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.

Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. For more good health information, visit: www.glennellis.com.