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.
If you are a dialysis patient, make sure you ask your doctor questions about how they reduce the risk of infection that can be acquired during dialysis. Even if you are not a dialysis patient, you need to ask questions about the safety of blood you might be receiving. It is always better to get blood from a known family member.
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.
Donating blood can save life. However, there is a risk of serious infection if you receive blood from an infected donor. Always try to get blood from a known family member without medical problems, Or ask your doctor where you can get safe blood for transfusion. You can also ask your doctor for alternatives to blood transfusion such as EPO injections. The Nigerian national blood transfusion service helps many hospitals provide safe blood
–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 [See below]
Over 1 million people in Nigeria are living with HIV infection or AIDS. Source: Kaiser Family Foundation
Almost 1 out of every 10 Nigerian adults has Hepatitis B infection. Soucre- US Centers for Disease Control-
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 number of people living with hepatitis C in Nigeria as well as other parts of Africa is not well documented (grey areas) except in Egypt which questionably has among the highest hepatitis C infection rates in the world. Source US Centers for Disease Control. However, based on sparse local data, it is estimated that somewhere between 1-3 in every 100 persons is infected with hepatitis C and the number is increasing.
To learn more about the nature of blood donation and transfusion services in Nigeria, click here.
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%.
Ask your doctor or nurse how infections are controlled in the medical center where you get your care. They should be prepared to tell you and you should be prepared to follow their advice as well.
To learn more about Hepatitis B virus infection, click here.
To learn more about Hepatitis C infection, click here.
To learn more about HIV infection, click here.
Solutions to the problem of viral infections in kidney disease and dialysis patients.
- 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.
- If you must get a blood transfusion, please ensure the supply is safe. Get a healthy family member to donate for you.
- Medical centers need to sterilize dialysis machines and other durable equipment in between treatments.
- 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.
- Observation of universal precautions in interactions between staff and patients. Handwashing and changing gloves is important.
- 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.
- 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.
If you are a kidney disease or dialysis patient, ask you doctor about getting the hepatitis vaccine. It will protect you from Hepatitis B infection and might even save your life.
References for further reading
- AO Adegoke, O Akanni, J Dirisu. Risk of transfusion-transmitted syphilis in a tertiary hospital in Nigeria. N Am J Sci. Feb 2011; 3(2):78-81
- FI Buseri, MA Muhibi, ZA Jeremiah. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus. Oct 2009; 7(4):293-299
- E Nwankwo, I Momodu, I Umar, B Musa, S Adeleke. Seroprevalence of major blood-borne infections among blood donors in Kano, Nigeria. Turk J Med Sci. 2012;42(2):337-341
- Uneke CJ, Ogbu O, Inyama PU, Anyanwu GI, Njoku MO, Idoko JH. Prevalence of hepatitis-B surface antigen among blood donors and human immunodefi ciency virus-infected patients in Jos, Nigeria. Mem Inst Oswaldo Cruz 2005; 100: 13-6.
- Egah DZ, Mandong BM, Iya D, Gomwalk NE, Audu ES, Banwat EB et al. Hepatitis C virus antibodies among blood donors in Jos, Nigeria. Annals of African Medicine 2004; 3: 35-7.
- Muktar HM, Suleiman AM, Jones M. Safety of blood transfusion: prevalence of Hepatitis B surface antigen in blood donors in Zaria, Northern Nigeria. Nigerian Journal of Surgical Research 2005; 7: 290-2.
- Ayolabi CL, Taiwo MA, Omilabu SA, Abebisi AO, Fatoba OM. Sero-prevalence of hepatitis C virus among donors in Lagos, Nigeria. African Journal of Biotechnology 2006; 5: 1944-6
- Chikwem JO, Mohammed I, Okwara GC, Ukwandu NC, Ola TO. Prevalence of transmissible blood infections among blood donors at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. East African Medical Journal 1997; 74: 213-6.
- Ejele O, Erhabor O, Nwauche C. Trends in the prevalence of some transfusion-transmissible infections among blood donors in Port Harcourt, Nigeria. Haema 2005; 8: 273-7.
- El Sayed NM, Gomatos PJ, Beck-Sagué CM, Dietrich U, von Briesen H, Osmanov S, Esparza J, Arthur RR, Wahdan MH, Jarvis WR. Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt. J Infect Dis. 2000 Jan;181(1):91-7.
- Velandia M, Fridkin SK, Cárdenas V, Boshell J, Ramirez G, Bland L, Iglesias A, Jarvis W. Transmission of HIV in dialysis centre. Lancet. 1995 Jun 3;345(8962):1417-22.