Home Health Glenn Ellis Ellis: Hepatitis Infection and Dialysis

Ellis: Hepatitis Infection and Dialysis

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By Glenn Ellis

Did you know African Americans are at increased risk of developing chronic kidney disease (CKD) leading to dialysis and transplant? Compared to other ethnic groups, the African American population has higher rates of diabetes and high blood pressure, which are the two leading causes of kidney disease.

Almost one in every three African Americans has high blood pressure. Because there are no warning signs, frequently people have high blood pressure or kidney disease and don’t even know they have a health problem. Even diabetes doesn’t always have symptoms.

Many African Americans already know they have diabetes or high blood pressure but are not aware they may also have kidney disease. They are shocked to be diagnosed with kidney failure and then immediately begin dialysis. Even though their kidney disease progressed over time to kidney failure, it’s as if it happened all of a sudden.

Talking about race is never just black and white, but when it comes to health, one thing is crystal clear: racial disparities exist and a variety of factors, including genetics, seem to play a role.

Time and space for this column doesn’t permit me going into the “why’s and wherefores.” I am only dealing with the “what is” as it relates to black folks.

Black Americans are three times more likely than white Americans to develop kidney disease and to require dialysis. This is both a troubling statement and a sad reality for the African-American population. Of great concern is that this racial disparity remains constant across all age groups. It may not make many headlines, but it needs to be brought to the attention of the public.

Given the staggering rates of kidney disease in the African-American community, African Americans need to pay particular attention to their kidney health. Kidney disease often has no symptoms until it is very advanced, so it can go unnoticed. Diabetes and high blood pressure are two of the leading causes of kidney disease, but the news is not all grim. Lifestyle changes can make a big difference in reducing one’s risk for developing kidney disease and early testing and treatment can slow or prevent the progression of kidney disease and its complications. As the saying goes, an ounce of prevention truly is worth a pound of cure.

Dialysis treatment – either in a hospital, a dialysis unit or at home – is needed when the kidneys cannot filter wastes from the body sufficiently. This is what is known as kidney failure.

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 and Prevention (CDC) says.

Kidney failure life expectancy, like anything depends on many things – some of which you can control, and others that you cannot control: age, gender, genes, race, diet, lifestyle choices, what caused your condition, 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.

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.

Estimates are that between 10 and 30 percent of dialysis patients carry the hepatitis C virus compared to 1 percent of the non-dialysis 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. If your medical facility does not follow guidelines for infection control in the right way, it is possible to get hepatitis C from being on dialysis.

Many dialysis patients, particularly African Americans, 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., dialysis 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.

This is all good news. There are new treatments for hepatitis C and a cure is now possible in most cases, including dialysis and kidney transplant patients.

 

Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Ellis is an active media contributor on Health Equity and Medical Ethics. 

 Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com