Hepatitis B and C in dialysis units in Kosova

  • Skender Telaku1Email author,

    Affiliated with

    • Hajrullah Fejza2,

      Affiliated with

      • Ymer Elezi3 and

        Affiliated with

        • Teuta Bicaj4

          Affiliated with

          Virology Journal20096:72

          DOI: 10.1186/1743-422X-6-72

          Received: 16 April 2009

          Accepted: 04 June 2009

          Published: 04 June 2009



          Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important causes of morbidity and mortality of hemodialysis (HD) patients. This study aimed to investigate the epidemiological and clinical features of HCV and HBV infections in six different HD units in Kosova.

          Five hundred and eighty-three end-stage kidney disease (ESKD) patients on maintenance HD from six HD centers in Kosova (358 female, 225 male, mean age 54,8 years (16–66) were included in this study. Data from databank of the National Blood Bank in Prishtina, as well as the data from the databank of the Transfusion Centers in Regional hospitals in Prizren, Peja, Gjilan, Mitrovica and Gjakova were taken in this study. Clinical data such as age, sex, HBsAg and anti-HCV antibody and primary causes of ESKD were examined.

          Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA).


          The T-test and x2 test were used to analyze the significance of the results. Among our HD patients HBsAg and anti-HCV antibody prevalence rate was 12%, respectively 43%. Chronic nephritis was a more frequent cause of ESKD among our HD patients. With unknown etiology were 23, 5% from them.


          HBV and HCV prevalence in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients.


          Hemodialysis (HD) patients are at high risk for viral hepatitis infections due to the high number of blood transfusion sessions, prolonged vascular access and the potential for exposure to infected patients and contaminated equipment [1, 2].

          The prevalence of HCV antibodies in nephrology units is high and has been reported to range from 5 to 54% [3]. HBV infection is less prevalent than HCV in HD units [4]. The rate of serum HBsAg seropositivity on maintenance HD in the developed world is currently low (0–10%) but outbreaks of acute HBV infection continue to occur in this setting. The prevalence of HBV infection within dialysis units in developing countries appears higher (2–20%) based on relatively several reports [5].

          The aim of the present study was to investigate the epidemiological and clinical features of HCV and HBV infections in six different HD units in Kosova.


          Clinical and epidemiological data were obtained from January to December 2008 in six different HD units in Kosova (Prishtina with 150, Prizren with 110, Peja with 74, Gjilani 80, Mitrovica 71 and Gjakova with 31 patients). Data from databank of the National Blood Bank in Prishtina as well the data from the above mentioned transfusion centers were used in this study. Clinical data such as age, sex, HBsAg and anti-HCV antibody and primary cause of ESKD were examined.

          Serological testing for HBV surface antigen and antibodies to HCV was performed using microparticle enzyme immunoassay (Abbott AxSM System, Abbott Laboratories, Abbott Park, Illinois, USA) and appropriate assays manufactured for the system (Abbott-AxSYM HBsAg version 2 and HCV version 3.0 assays). The T-test and x2 test were used to analyze the significance of the results.


          From 583 patients, 358 (61,4%) of them were female and 225(38,6%) were male, and the age ranged from 16–66 years with mean age 54.8 years, (Table 1).
          Table 1

          The number and sex of tested patients in Hemodialysis Unit













          The major primary renal diseases in the end stage of kidney disease (ESKD) patients included chronic nephritis (23, 2%), diabetes mellitus (19,2%), hypertension (13,2%), urologic diseases (7,3%), cystic renal diseases (6,1%), and nonspecific chronic pyelonephritis (6%). Four patients (0, 7%)were with systemic lupus erytemathosus (SLE). There were 23, 5% (137 patients) with unknown etiology, (Figure 1).
          Figure 1

          Etiology of prevalent regular HD patients.

          More than 80% of patients were between age 26 and 65 years old whereas only 7.5% of them were younger than 25 year, (Figure 2).
          Figure 2

          Age distribution of prevalent regular HD patients.

          In this study, 70 patients (12%) were HBsAg positive, and 250 of them (43%) were anti HCV positive, (Figure 3).
          Figure 3

          HBV and HCV of prevalent regular patients HD patients.


          In patients on maintenance HD, the risk of hepatitis is still a serious problem despite the availability of serological tests and vaccines for hepatitis B virus infection and universal precaution standards and infection control measures. Available data suggest that HCV has become the most common cause of acute hepatitis in dialysis patients and dialysis staff members, following the implementation of infection control measures for HBV, [6].

          In our study, the prevalence of HBsAg was 12%.

          Results of the examination which were done with 165 HD patients from three units in Kosova (Prishtina, Prizren and Mitrovica) during first six months of 2003 showed that prevalence of anti HCV antibodies and HBsAg were 38.78%, respectively 24,24%. This study showed that duration of dialysis and number of transfusions are risk factors for development of HBV and HCV infection (p < 0, 05) [7].

          The results of our last study demonstrate a decrease in prevalence of HBV positive HD patients during from 24, 24% to 12% over six years. This decrease of HBV infection in dialysis patients over the years despite implementation of universal precaution is a result of advent of recombinant human erythropoietin and HBV vaccination in last years. This prevalence is higher than in USA, Croatia, Japan, Casablanca, Iran, Jordan, Kenya, Saudi Arabia, Hong Kong and lower than India, Taiwan, Romania, Greece, Spain, Turkey and Brazil [823].

          The HBV prevalence among the blood donors of Kosova is 4, 2%, which range Kosova to the second zone according to the CDC classification of the geographical expanding of the HBV infection. The HCV prevalence among the blood donors in Kosova is 0,3%, compared to other European countries this level of prevalence is relatively low [24].

          Results of the study which were done with Kosovar refugees who had arrived in southern Italy in 1999 revealed that HBV infection seems to be at an intermediate level of endemicity. At the same time this study indicates that the level of endemicity of HCV infection in Kosovar population is low [25].

          HCV prevalence in HD varies geographically, both within and between countries [26].

          The reported anti-HCV seropositivity since 1999 ranges from low (1.9%) in the Slovenia [27] to high (80%) in Senegal [28]. HCV seroprevalence in the HD population was 59% in Bosnia and Herzegovina, 6.8% in Belgium, 16.3% in France, 6.1% in Germany, 10%–29% in Greece, 22.5%–32.1% in Italy, 75% in Moldavia, 3.4% in the Netherlands, 11% in Sweden, 7%–23.3% in the USA, 4% in the UK, 20.5% in Libya, 71% in Kuwait, 23.7% in Sudan, 19% – 41.7% in Tunisia, 8.4%–43.2% in Brazil, 6.7% in Mexico, 59.3% in Peru, 3.5% in Puerto Rico and 13.2% in Iran [2947]

          The prevalence of HCV among our HD patients is 43%, compared with above mentioned study [7] there is not a decrease in prevalence of HCV in our HD patients over last six years. In our opinion environment condition in our hemodialysis units are responsible for high prevalence of HCV in our HD patients.


          In summary, the prevalence of HBV and HCV in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients.


          Authors’ Affiliations

          Gastroenterology Unit, University Clinical Center of Kosova
          Sector for Public Health, Municipality of Prishtina
          Nephrology Unit, University Clinical Center of Kosova
          Department for Prosthetics Dentistry, University Dentistry Clinical Center of Kosova


          1. Meyers CM, Seef LB, Stehman-Breen CO, Hoofnagle JH: Hepatitis C and renal disease: an update. Am J Kidney Dis 2003,42(4):631–657.View ArticlePubMed
          2. Fabrizi F, de Vecchi AF, Como G, Lunghi G, Martin P: De novo HCV infection among dialysis patients: a prospective study by HCV core antigen ELISA assay. Aliment Pharmacol Ther 2005,21(7):861–869.View ArticlePubMed
          3. Wright TL, Pereira BJG: Hepatitis C virus: a threat without a cure to the patient with ESRD. Semin Dial 1997,10(5):241–247.View Article
          4. Oesterreicher C, Muller C: HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chronic hemodialysis. Kidney international 1995, 48:1967–1971.View ArticlePubMed
          5. Fabrizi F, Messa P, Martin P: Hepatitis B virus infection and the dialysis patient. Semin Dial 2008,21(5):440–446.View ArticlePubMed
          6. Niu MT, Coleman PJ, Alter MJ: Multicenter study of hepatitis C virus infection in chronic hemodialysis patients and hemodialysis staff members. Am J Kidney Dis 1993,22(4):568–573.PubMed
          7. Telaku S, Zekaj S, Avdijaj Xh, Elezi Y, Kuqi Xh, Zylfiu B, Rudhani I, Hasanxhekaj V, Fejza H: Prevalence of hepatitis B and C infection in dialysis patient in Kosova. The Turkish Journal of Gastroenterology 2003,14(Suppl 1):106.
          8. Tokars JI, Finelli L, Alter MJ, Arduino MJ: National surveillance of dialysis-associated diseases in the United States 2001. Semin Dial 2004,17(4):310–319.View ArticlePubMed
          9. Kes P, Slavicek J, Jankovic N: Prevention and treatment of hepatitis B in patients on hemodialysis and vaccination of hemodialysis health personnel against hepatitis B. Acta Med Croatica 2005,59(5):479–482.PubMed
          10. Oguchi H, Miyasaka M, Tokunaga S: Hepatitis virus infection (HBV and HCV) in eleven Japanese hemodialysis units. Clin Nephrol 1992,38(1):36–43.PubMed
          11. Boulaajaj K, Elomari Y, Elmaliki B: Prevalence of hepatitis C, hepatitis B and HIV infection among haemodialysis patients in Ibn-Rochd university hospital, Casablanca. Nephrol Ther 2005,1(5):274–284.PubMed
          12. Taremi M, Khoshbaten M, Gachkar L, EhsaniArdakani M, Zali M: Hepatitis E virus infection in hemodialysis patients: A seroepidemiological survey in Iran. BMC Infect Dis 2005,5(1):36–38.View ArticlePubMed
          13. Munter H, Yousef A: Hepatitis B infection among Patients Receiving Chronic Hemodialysis at Royal Medical Services in Jordan. Saudi J Kidney Dis Transpl 2008,19(2):260–267.
          14. Otedo AE, Mc'Ligeyo SO, Okoth FA: Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country. S Afr Med J 2003,93(5):380–384.PubMed
          15. Khan LA, Khan SA: Prevalence of Hepatitis B and C markers in patients on maintenance hemodialysis in Najran. Saudi Med J 2001,22(7):641–642.PubMed
          16. Leung CB, Ho YW, Chau KF, Choy BY, Tsang WK, Lui SF: Renal replacement therapy for chronic hepatitis B carrier: A subgroup analysis from the Hong Kong Renal Registry 1995–1999. Hong Kong J Nephrol 2000, 2:104–109.View Article
          17. Chattopadhyay S, Rao S, Das BC: Prevalence of transfusion-transmitted virus infection in patients on maintenance hemodialysis from New Delhi, India. Hemodial Int 2005,9(4):362–366.View ArticlePubMed
          18. Chen KS, Lo SK, Lee N, Leu ML, Huang CC, Fang KM: Superinfection with hepatitis C virus in hemodialysis patients with hepatitis B surface antigenemia: Its prevalence and clinical significance in Taiwan. Nephron 1996,73(2):158–164.View ArticlePubMed
          19. Covic A, Iancu L, Apetrei C: Hepatitis virus infection in haemodialysis patients from Moldavia. Nephrol Dial Transplant 1999,14(1):40–45.View ArticlePubMed
          20. Siagris D, Christofidou M, Triga K: Occult hepatitis B virus infection in hemodialysis patients with chronic HCV infection. J Nephrol 2006,19(3):327–333.PubMed
          21. Loza Munarriz C, Depaz Dolores M, Jara M: Rate of serological markers of hepatitis B and C viruses in first-time users of the hemodialysis program at Hospital Nacional Cayetano Heredia (HNCH). Rev Gastroenterol Peru 2005,25(4):320–327.PubMed
          22. Yakaryilmaz F, Gurbuz OA, Guliter S: Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients. Ren Fail 2006,28(8):729–735.View ArticlePubMed
          23. Ferreira RC, Teles SA, Dias MA: Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: Prevalence, risk factors and genotypes. Mem Inst Oswaldo Cruz 2006,101(6):689–692.View ArticlePubMed
          24. Fejza H, Telaku S: Prevalence of HBV and HCV among blood donors in Kosova. Virol J 2009, 13:6–21.
          25. Chironna M, Germinario C, Lopalco PL, Carrozini F, Quatro M: Prevalence of hepatitis virus infections in Kosovar refugees. Int J Infect Dis 2001,5(4):209–213.View ArticlePubMed
          26. Jadoul M, Cornu C, van Ypersele de Strihou C: Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998, 53:1022–1025.View ArticlePubMed
          27. Buturović-Ponikvar J: Renal replacement therapy in Slovenia: annual report 2001. Nephrol Dial Transplant 2003,18(Suppl 5):v53-v55.View ArticlePubMed
          28. Diouf ML, Diouf B, Niang A, Ka EH, Pouye A, Seck A, Raphenon G, Moreira-Diop T: Prevalence of hepatitis B and C viruses in a chronic hemodialysis center in Dakar. Dakar Med 2000, 45:1–4.PubMed
          29. Ahmetagić S, Muminhodzić K, Cickusić E, Stojić V, Petrović J, Tihić N: Hepatitis C infection in risk groups. Bosn J Basic Med Sci 2006, 6:13–17.PubMed
          30. Jadoul M, Poignet JL, Geddes C, Locatelli F, Medin C, Krajewska M, Barril G, Scheuermann E, Sonkodi S, Goubau P: The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis. Nephrol Dial Transplant 2004, 19:904–909.View ArticlePubMed
          31. Salama G, Rostaing L, Sandres K, Izopet J: Hepatitis C virus infection in French hemodialysis units: a multicenter study. J Med Virol 2000, 61:44–51.View ArticlePubMed
          32. Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE: Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Gut 2002, 51:429–433.View ArticlePubMed
          33. Rigopoulou EI, Stefanidis I, Liaskos C, Zervou EK, Rizos C, Mina P, Zachou K, Syrganis C, Patsidis E, Kyriakopoulos G, Sdrakas L, Tsianas N, Dalekos GN: HCV-RNA qualitative assay based on transcription mediated amplification improves the detection of hepatitis C virus infection in patients on hemodialysis: results from five hemodialysis units in central Greece. J Clin Virol 2005, 34:81–85.View ArticlePubMed
          34. Lombardi M, Cerrai T, Geatti S, Negroni S, Pertusini L, Pegoraro M, Di Lullo G: Results of a national epidemiological investigation of HCV infection in dialysis patients. EDTNA ERCA J 1999, 25:38–42.PubMed
          35. Covic A, Iancu L, Apetrei C, Scripcaru D, Volovat C, Mititiuc I, Covic M: Hepatitis virus infection in haemodialysis patients from Moldavia. Nephrol Dial Transplant 1999, 14:40–45.View ArticlePubMed
          36. Schneeberger PM, Keur I, van Loon AM, Mortier D, de Coul KO, van Haperen AV, Sanna R, van Der Heijden TG, van Den Hoven H, van Hamersvelt HW, Quint W, van Doorn LJ: The prevalence and incidence of hepatitis C virus nfections among dialysis patients in the Netherlands: a nationwide prospective study. J Infect Dis 2000, 182:1291–1299.View ArticlePubMed
          37. Almroth G, Ekermo B, Månsson AS, Svensson G, Widell A: Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long-term follow up (1989–January 1997). J Intern Med 2002, 251:119–128.View ArticlePubMed
          38. Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, Miller LG, Daar ES, Gjertson DW, Kopple JD, Greenland S: Hepatitis C virus and death risk in hemodialysis patients. J Am Soc Nephrol 2007, 18:1584–1593.View ArticlePubMed
          39. Wreghitt TG: Blood-borne virus infections in dialysis units – a review. Rev Med Virol 1999, 9:101–109.View ArticlePubMed
          40. Daw MA, Elkaber MA, Drah AM, Werfalli MM, Mihat AA, Siala IM: Prevalence of hepatitis C virus antibodies among different populations of relative and attributable risk. Saudi Med J 2002, 23:1356–1360.PubMed
          41. El-Amin HH, Osman EM, Mekki MO, Abderlraheem MB, Ismail MO, Yousif ME, Abass A, Elhaj HS, Ammar HK: Hepatitis C virus infection in hemodialysis patients in Sudan:Two centers report. Saudi J Kidney Dis Transpl. 2007,18(1):101–106.PubMed
          42. Bouzgarrou N, Fodha I, Othman SB, Achour A, Grattard F, Trabelsi A, Pozzetto B: Evaluation of a total core antigen assay for the diagnosis of hepatitis C virus infection in hemodialysis patients. J Med Virol 2005, 77:502–508.View ArticlePubMed
          43. Lopes EP, Gouveia EC, Albuquerque AC, Sette LH, Mello LA, Moreira RC, Coelho MR: Determination of the cutoff value of serum alanine aminotransferase in patients undergoing hemodialysis, to identify biochemical activity in patients with hepatitis C viremia. J Clin Virol 2006, 35:298–302.View ArticlePubMed
          44. Méndez-Sánchez N, Motola-Kuba D, Chavez-Tapia NC, Bahena J, Correa-Rotter R, Uribe M: Prevalence of hepatitis C virus infection among hemodialysis patients at a tertiary care hospital in Mexico City, Mexico. J Clin Microbiol 2004, 42:4321–4322.View ArticlePubMed
          45. Sanchez JL, Sjogren MH, Callahan JD, Watts DM, Lucas C, Abdel-Hamid M, Constantine NT, Hyams KC, Hinostroza S, Figueroa-Barrios R, Cuthie JC: Hepatitis C in Peru: risk factors for infection, potential iatrogenic transmission, and genotype distribution. Am J Trop Med Hyg 2000, 63:242–248.PubMed
          46. López-Navedo PJ, Lebrón-Rivera R, González-Trápaga J, Weber-Acevedo J, Lefevre-Ramos E, Flores-de Hostos E, Jaume-Anselmi F, Ramírez-Rivera J: Prevalence of hepatitis C virus infection at three hemodialysis units in the western region of Puerto Rico. Bol Asoc Med P R 1999, 91:100–102.PubMed
          47. Alavian SM, Einollahi B, Hajarizadeh B, Bakhtiari S, Nafar M, Ahrabi SS: Prevalence of hepatitis C virus infection and related risk factors among Iranian haemodialysis patients. Nephrology (Carlton) 2003, 8:256–260.View Article

          This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.