The prevalence of hepatitis C virus in hemodialysis patients in Pakistan: A systematic review and meta-analysis.
- 作者列表："Akhtar S","Nasir JA","Usman M","Sarwar A","Majeed R","Billah B
BACKGROUND:Hepatitis C virus (HCV) infection is one of the most common bloodborne viral infections reported in Pakistan. Frequent dialysis treatment of hemodialysis patients exposes them to a high risk of HCV infection. The main purpose of this paper is to quantify the prevalence of HCV in hemodialysis patients through a systematic review and meta-analysis. METHODS:We systematically searched PubMed, Medline, EMBASE, Pakistani Journals Online and Web of Science to identify studies published between 1 January 1995 and 30 October 2019, reporting on the prevalence of HCV infection in hemodialysis patients. Meta-analysis was performed using a random-effects model to obtain pooled estimates. A funnel plot was used in conjunction with Egger's regression test for asymmetry and to assess publication bias. Meta-regression and subgroup analyses were used to identify potential sources of heterogeneity among the included studies. This review was registered on PROSPERO (registration number CRD42019159345). RESULTS:Out of 248 potential studies, 19 studies involving 3446 hemodialysis patients were included in the meta-analysis. The pooled prevalence of HCV in hemodialysis patients in Pakistan was 32.33% (95% CI: 25.73-39.30; I2 = 94.3%, p < 0.01). The subgroup analysis showed that the prevalence of HCV among hemodialysis patients in Punjab was significantly higher (37.52%; 95% CI: 26.66-49.03; I2 = 94.5, p < 0.01) than 34.42% (95% CI: 14.95-57.05; I2 = 91.3%, p < 0.01) in Baluchistan, 27.11% (95% CI: 15.81-40.12; I2 = 94.5, p < 0.01) in Sindh and 22.61% (95% CI: 17.45-28.2; I2 = 78.6, p < 0.0117) in Khyber Pukhtoonkhuwa. CONCLUSIONS:In this study, we found a high prevalence (32.33%) of HCV infection in hemodialysis patients in Pakistan. Clinically, hemodialysis patients require more attention and resources than the general population. Preventive interventions are urgently needed to decrease the high risk of HCV infection in hemodialysis patients in Pakistan.
背景: 丙型肝炎病毒 (HCV) 感染是巴基斯坦报道的最常见的血源性病毒感染之一。血液透析患者的频繁透析治疗使他们暴露于HCV感染的高风险。本文的主要目的是通过系统回顾和荟萃分析来量化血液透析患者中HCV的患病率。 方法: 我们系统地检索了PubMed、Medline、EMBASE、巴基斯坦在线期刊和Web of Science，以确定1995年1月1日至20 19年10月30日期间发表的关于血液透析患者HCV感染流行率的研究。使用随机效应模型进行荟萃分析以获得汇总估计。漏斗图与Egger回归检验结合使用，用于不对称和评估发表偏倚。使用Meta回归和亚组分析确定纳入研究中异质性的潜在来源。本次审查在PROSPERO (注册号CRD42019159345) 上注册。 结果: 在248个潜在研究中，19个研究包括3446名血液透析患者被纳入荟萃分析。巴基斯坦血液透析患者中HCV的合并患病率为32.33% (95% CI: 25.73-39.30; I2 = 94.3%，p <0.01)。亚组分析显示，旁遮普省血液透析患者中HCV患病率 (37.52%; 95% CI: 26.66-49.03; I2 = 94.5，p <0.01) 显著高于俾路支省的34.42% (95% CI: 14.95-57.05; I2 = 91.3%，p <0.01)，27.11% (95% CI: 15.81-40.12;I2 = 94.5，p <0.01) 在信德省和22.61% (95% CI: 17.45-28.2; I2 = 78.6，p <0.0117) 在Khyber Pukhtoonkhuwa。 结论: 在这项研究中，我们发现在巴基斯坦的血液透析患者中HCV感染的高患病率 (32.33%)。临床上，血液透析患者比普通人群需要更多的关注和资源。迫切需要预防性干预措施来降低巴基斯坦血液透析患者HCV感染的高风险。
METHODS:AIM:Clinical interpretation of B-type natriuretic peptide (BNP) levels in haemodialysis (HD) patients for fluid management remains elusive. METHODS:We conducted a retrospective observational monocentric study. We built a mathematical model to predict BNP levels, using multiple linear regressions. Fifteen clinical/biological characteristics associated with BNP variation were selected. A first cohort of 150 prevalent HD (from September 2015 to March 2016) was used to build several models. The best model proposed was internally validated in an independent cohort of 75 incidents HD (from March 2016 to December 2017). RESULTS:In cohort 1, mean BNP level was 630 ± 717 ng/mL. Cardiac disease (CD - stable coronary artery disease and/or atrial fibrillation) was present in 45% of patients. The final model includes age, systolic blood pressure, albumin, CD, normo-hydrated weight (NHW) and the fluid overload (FO) assessed by bio-impedancemetry. The correlation between the measured and the predicted log-BNP was 0.567 and 0.543 in cohorts 1 and 2, respectively. Age (β = 3.175e-2 , P < 0.001), CD (β = 5.243e-1 , P < 0.001) and FO (β = 1.227e-1 , P < 0.001) contribute most significantly to the BNP level, respectively, but within a certain range. We observed a logistic relationship between BNP and age between 30 and 60 years, after which this relationship was lost. BNP level was inversely correlated with NHW independently of CD. Finally, our model allows us to predict the BNP level according to the FO. CONCLUSION:We developed a mathematical model capable of predicting the BNP level in HD. Our results show the complex contribution of age, CD and FO on BNP level.
METHODS:AIM:The removal of cysteine during a dialysis procedure may affect glutathione (GSH) concentration, allowing haemodialysis (HD) patients to become more susceptible to oxidative damage. This study was performed to determine whether the change of GSH/glutathione disulfide (GSSG) redox state and GSH redox potential were linked with the change of cysteine or oxidative stress in patients receiving HD treatment. METHODS:Sixty-seven HD patients who had received regular HD treatment were recruited. Plasma GSH, GSSG, cysteine and malondialdehyde (MDA) were measured at both pre- and post-HD. RESULTS:Plasma cysteine, GSH and GSSG levels significantly decreased after the completion of HD, compared to the levels at pre-HD. Plasma MDA concentration, GSH/GSSG ratio and GSH redox potential remained constant during the dialysis session. Plasma GSH and GSSG were positively associated with plasma MDA at post-HD, while GSH redox potential was negatively associated with plasma MDA at post-HD. However, plasma GSH, GSSG, GSH/GSSG ratio and GSH redox potential were not associated with plasma cysteine at either pre- or post-HD. CONCLUSION:The GSH and GSSG levels were significantly utilized during a HD session, and their levels were significantly associated with increased oxidative stress. HD patients may require higher GSH demands to cope with increased oxidative stress during an HD session.
METHODS:OBJECTIVE:Although there is no consensus on how to use an electrocardiogram (ECG) in patients with hyperkalemia, physicians often obtain it in the acute setting when diagnosing and treating hyperkalemia. The objective of this study is to evaluate if physicians are able to detect hyperkalemia based on the ECG. METHODS:The study was conducted at a large county hospital with a population of end stage renal disease (ESRD) patients who received hemodialysis (HD) solely on an emergent basis. Five hundred twenty eight ECGs from ESRD patients were evaluated. The prevalence of hyperkalemia was approximately 60% in this cohort, with at least half of them in the severe hyperkalemia range (K ≥ 6.5 mEq/L). RESULTS:The mean sensitivity and specificity of the emergency physicians detecting hyperkalemia were 0.19 (± 0.16) and 0.97(± 0.04) respectively. The mean positive predictive value of evaluators for detecting hyperkalemia was 0.92 (±0.13) and the mean negative predictive value was 0.46 (± 0.05). In severe hyperkalemia (K ≥ 6.5 mEq/L), the mean sensitivity improved to 0.29 (± 0.20), while specificity decreased to 0.95 (±0.07). CONCLUSION:An ECG is not a sensitive method of detecting hyperkalemia and should not be relied upon to rule it out. However, the ECG has a high specificity for detecting hyperkalemia and could be used as a rule in test.