Abstracts
Introduction and Objective:
This study aimed at determining the prevalence of hepatitis C among 649 patients diagnosed with chronic or acute kidney disease − patients were undergoing hemodialysis treatment at a large hemodialysis center in Porto Alegre-RS, from January through December, 2012 –, as well as relating our data to that presented in the national census, reporting cases of coinfection by hepatitis C and human immunodeficiency virus (HIV), and defining the demographic profile of these patients.
Method:
An observational cross-sectional study was conducted and data was obtained from information in patients’ electronic medical records.
Result and conclusion:
The prevalence of hepatitis C in this study was 10.17% of the sampled population. However, further analysis of other liver centers would be required to estimate an accurate prevalence rate of infection caused by the hepatitis C virus in patients undergoing hemodialysis in Porto Alegre.
acute renal failure; chronic renal failure; hemodialysis; hepatitis C
Introdução e objetivo:
Este trabalho teve como objetivo determinar a prevalência de hepatite C em 649 pacientes diagnosticados com doença renal aguda ou crônica − eles se submeteram a tratamento hemodialítico em uma unidade de hemodiálise de um hospital de grande porte de Porto Alegre-RS, de janeiro a dezembro de 2012 −, bem como relacionar os dados encontrados com os apresentados no censo nacional, relatar casos de coinfecção de hepatite C e vírus da imunodeficiência humana (HIV) e, finalmente, conhecer o perfil demográfico dos pacientes.
Método:
Realizou-se um estudo observacional do tipo transversal cujos dados foram obtidos por meio de informações dos prontuários eletrônicos dos pacientes.
Resultado e Conclusão:
A prevalência de hepatite C encontrada no presente estudo foi de 10,17% da população amostrada. Entretanto, seriam necessárias mais análises em outros centros a fim de estimar a real prevalência para infecção pelo vírus da hepatite C em pacientes submetidos a hemodiálise em Porto Alegre.
doença renal aguda; doença renal crônica; hemodiálise; hepatite C
INTRODUCTION
Renal disease is defined by damaged or decreased kidney function. Renal damage can result from any disease potentially able to reduce the functional capacity of the kidneys. It is a multifactorial disease that represents a serious public health problem due to the increasing percentage of patients who become chronically ill, and to the numerous comorbidities that often accompany it. There are several treatment forms, including hemodialysis. The disease can be controlled for some time, but it is progressive, incurable and has high morbidity and mortality rates(11 BARROS, E. et al. Nefrologia: rotinas, diagnóstico e tratamento. 3. ed. Porto Alegre, RS: Artmed, 2006.,1212 KIRSZTAJN, G. M. Diagnóstico laboratorial em Nefrologia. São Paulo, SP: Sarvier, 2010.).
Hepatitis C is a liver disease, caused by hepatitis C virus (HCV), a ribonucleic acid
(RNA) virus of the Flaviviridae family, whose replication process takes
place in the hepatocyte cytoplasm. The clinical manifestations of hepatitis C are
classified as acute and chronic. The acute infection is usually asymptomatic, but has a
high chronicity rate that may reach 80% of the cases(1515 NEUMANN, A. U. et al. Hepatitis C viral dynamics in
vivo and the antiviral efficacy of interferon-alpha therapy.
Science, v. 282, n. 5386, p. 103-7, 1998. Available at:
<http://www.ncbi.nlm.nih.gov/pubmed/9756471>. Accessed on: May 17,
2012.
http://www.ncbi.nlm.nih.gov/pubmed/97564...
).
Renal patients that undergo hemodialysis are particularly prone to contamination by HCV
due to the several risk factors they are exposed to. Among these factors, we may draw
attention to treatment duration, blood transfusions and the virus prevalence in the
hemodialysis unit(1212 KIRSZTAJN, G. M. Diagnóstico laboratorial em
Nefrologia. São Paulo, SP: Sarvier, 2010.,1313 LEÃO, J. R.; PACE, F. H. L.; CHEBELI, J. M. F. Infecção pelo vírus da
hepatite C em pacientes em hemodiálise: prevalência e fatores de risco. Arq
Gastroenterol, São Paulo, v. 47, n. 1, p. 28-34, 2010. Available at:
<http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032010000100006>.
Accessed on: May 17, 2012.
http://www.scielo.br/scielo.php?script=s...
).
According to Boletim Epidemiológico de Hepatites Virais de 2012, from
1999 to 2011, in the South region, 18,307 confirmed cases of hepatitis C were reported
to the Notifiable Diseases Information System (SINAN). This represents 22.3% of the
notified cases in Brazil. Most of them were in the state of Rio Grande do Sul (58.2%),
followed by Santa Catarina (25.6%) and Paraná (16.2%)(33 BRASIL. Ministério da Saúde. Boletim Epidemiológico de Hepatites Virais
2012. Publicado em 2012. Available at:
<http://www.aids.gov.br/publicacao/2012/boletim-epidemiologico-de-hepatites-virais-2012>.
Accessed on: May 10, 2013.
http://www.aids.gov.br/publicacao/2012/b...
).
Concerning renal disease, the estimated number of patients undergoing dialysis in Brazil
in 2011 was 91,314. Prevalence estimates for 2011 were 475 dialysis patients per million
of the population. Among them, 90.6% were on hemodialysis, and 31.5% were 65 years or
older. For 2011, the estimated number of patients beginning dialysis was 28,680, and the
annual mortality rate was 19.9%(1717 SESSO, R. C. C. et al. Diálise crônica no Brasil −
relatório do Censo Brasileiro de Diálise. J Bras Nefrol, São Paulo,
v. 34, n. 3, p. 272-7, 2012. Available at:
<http://www.jbn.org.br/detalhe_artigo.asp?id=1483>. Accessed on: December 10,
2012.
http://www.jbn.org.br/detalhe_artigo.asp...
).
OBJECTIVE
Based on the relevance of the subject, this work aimed at determining the prevalence of hepatitis C in patients diagnosed with acute or chronic renal disease. All of them underwent hemodialysis at a hemodialysis unit in a large hospital in Porto Alegre-RS, from January to December, 2012. This paper also aimed at relating the gathered data to the national census mass of data, reporting cases of patients coinfected with hepatitis C and the human immunodeficiency virus (HIV), and finally, defining the demographic profile of the patients.
METHOD
A cross-sectioned observational study, with a descriptive analytical approach, was carried out for the determination of hepatitis C prevalence in 649 patients diagnosed with acute or chronic renal disease undergoing hemodialysis from January to December 2012. The used data base obtained information from the electronic records of patients.
The survey was conducted at a hemodialysis center of a large hospital in Porto Alegre-RS. That unit serves exclusively their inpatients from the Unified Health System (SUS) who began the hemodialysis treatment due to diagnoses of renal failure. It also serves inpatients with other diseases who present with renal failure, coming from other hemodialysis clinics of the metropolitan region or the inner state. The center also provides treatment for a group of patients with chronic renal failure who are regularly served at a hemodialysis program in the institution.
The sample was composed of 649 patients with acute or chronic renal failure, undergoing hemodialysis from January to December 2012 in the surveyed institution.
This work was submitted to and approved by the Ethics Committee of Universidade Feevale, according to report nº 245.621. It was also assessed by the Ethics Committee of Grupo Hospitalar Conceição, being approved according to report no. 308.906.
In order to access the data bank of the surveyed institution, a data use agreement was signed.
Results
The results presented in Table 1 refer to a sample of 649 investigated patients receiving hemodialysis from January to December 2012.
Absolute and relative distribution by sex, age group, city, color, mean and SD of age, HCV infection, HIV infection and HCV/HIV coinfection for the group of 649 patients(44 CALLEGARI-JACQUES, S. M. Bioestatística: princípios e aplicações. Porto Alegre, RS: Artmed, 2007.)
The results from Table 2 refer to the 66 patients diagnosed as being anti-HCV positive.
Absolute and relative distribution by sex, age group, city and ethnicity/race and mean age and SD of age for the group of 66 patients with hepatitis C(44 CALLEGARI-JACQUES, S. M. Bioestatística: princípios e aplicações. Porto Alegre, RS: Artmed, 2007.)
Finally, the results from Table 3 refer to the 12 patients coinfected with HCV and HIV.
Absolute and relative distribution by sex, age group, city and ethnicity/race, and mean age and SD of age for the group of 12 patients with HIV/HCV coinfection(44 CALLEGARI-JACQUES, S. M. Bioestatística: princípios e aplicações. Porto Alegre, RS: Artmed, 2007.)
The Ministry of Health, at Boletim Epidemiológico de Hepatites Virais de
2012, reveals an index of 1.38% of prevalence of hepatitis C for the general
population. According to the same study, 82,041 cases of hepatitis C were confirmed in
Brazil from 1999 to 2011, with 22.3% only in the South region. Among these 22.3%
national cases, 58.2% occurred in Rio Grande do Sul (RS). Among the capitals of the
South region, in 2010, the highest case detection rate per 100,000 inhabitants was
observed in Porto Alegre-RS: 40.4%(33 BRASIL. Ministério da Saúde. Boletim Epidemiológico de Hepatites Virais
2012. Publicado em 2012. Available at:
<http://www.aids.gov.br/publicacao/2012/boletim-epidemiologico-de-hepatites-virais-2012>.
Accessed on: May 10, 2013.
http://www.aids.gov.br/publicacao/2012/b...
).
According to the Brazilian Society of Nephrology (SBN), the prevalence rates of
hepatitis C in dialysis centers in the whole Brazil was 19.9% in 2000, and 9.1% in 2007,
showing a 50% reduction in less than 10 years(1818 SESSO, R. C. C. et al. Resultados do Censo de Diálise
da SBN. J Bras Nefrol, v. 29, n. 4, p. 197-202, 2007. Available at:
<http://www.jbn.org.br/detalhe_artigo.asp?id=128>. Accessed on: June 30,
2012.
http://www.jbn.org.br/detalhe_artigo.asp...
).
DISCUSSION
The prevalence of hepatitis C observed in the present study (10.17%) may be considered
low when compared to the survey by Gomes et al. (2006), which reported
29.1% of HCV infection in dialysis patients in Porto Alegre-RS. It is very similar to
the study by Leão et al. (2007), in which 10.7% were described in Juiz
de Fora-MG(99 GOMES, M. et al. Prevalência da soropositividade do
anti-HCV em pacientes dialisados. Rev Saúde Públ, v. 40, n. 5, p.
931-4, 2006. Available at: <http://www.scielo.br/pdf/rsp/v40n5/26.pdf>.
Accessed on: June 21, 2012.
http://www.scielo.br/pdf/rsp/v40n5/26.pd...
,1313 LEÃO, J. R.; PACE, F. H. L.; CHEBELI, J. M. F. Infecção pelo vírus da
hepatite C em pacientes em hemodiálise: prevalência e fatores de risco. Arq
Gastroenterol, São Paulo, v. 47, n. 1, p. 28-34, 2010. Available at:
<http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032010000100006>.
Accessed on: May 17, 2012.
http://www.scielo.br/scielo.php?script=s...
). However, when compared to data for
the general population (1.38%), this seroprevalence of hepatitis C found in patients
with renal failure undergoing hemodialysis is considered high(1414 MELLO, L. A. et al. Soroprevalência da hepatite C em
pacientes hemodialisados. Rev Soc Bras Med Trop, v. 40, n. 3, p.
290-4, 2007. Available at:
<http://www.scielo.br/scielo.php?pid=s003786822007000300008&script=sci_arttext>.
Accessed on: May 17, 2012.
http://www.scielo.br/scielo.php?pid=s003...
,1515 NEUMANN, A. U. et al. Hepatitis C viral dynamics in
vivo and the antiviral efficacy of interferon-alpha therapy.
Science, v. 282, n. 5386, p. 103-7, 1998. Available at:
<http://www.ncbi.nlm.nih.gov/pubmed/9756471>. Accessed on: May 17,
2012.
http://www.ncbi.nlm.nih.gov/pubmed/97564...
).
An important cause of HCV infection in hemodialysis is the practice of transfusion of
blood and/or blood components. The study by Yonemura et al. verified
that from 52 patients who had undergone transfusion, 21 (40.4%) were HCV-antibody
positive, while among the 182 patients with no history of transfusion, just 20 (11%) had
this antibody. These data may be compared to the study by Hinrichsen et
al., which also verified increased prevalence of anti-HCV antibody in
patients undergoing multiple transfusions(1010 HINRICHSEN, H. et al. Prevalence and risk factors of
hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796
patients. Liver Disease, v. 51, n. 3, p. 429-33, 2002. Available at:
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773370/>. Accessed on: April 3,
2014.
http://www.ncbi.nlm.nih.gov/pmc/articles...
,2020 YONEMURA, K. et al. High prevalence of hepatitis C
virus antibody in patients with chronic renal failure at the start of hemodialysis
therapy. Nephron, v. 73, n. 3, p. 484-5, 1996. Available at:
<http://www.karger.com/Article/Pdf/189117>. Accessed on: April 3,
2014.
http://www.karger.com/Article/Pdf/189117...
). Another
factor possibly related to the increase of this prevalence is the duration of dialysis
treatment, as observed in other works(66 CARNEIRO, M. A. S. et al. Hepatitis C prevalence and
factors in hemodialysis patients in Central Brazil: a survey by polymerase chain
reaction and serological methods. Mem Inst Oswaldo Cruz, v. 96, n.
6, p. 765-9, 2001. Available at:
<http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762001000600003&lng=pt>.
Accessed on: April 3, 2014.
http://www.scielo.br/scielo.php?script=s...
,1616 SALAMA, G. et al. Hepatitis C virus infection in French
hemodialysis units: a multicenter study. J Med Virol, v. 61, n. 1,
p. 44-51, 2000. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/10745231>.
Accessed on: April 3, 2014.
http://www.ncbi.nlm.nih.gov/pubmed/10745...
,1919 VANDERBORGHT, B. O. M. et al. High prevalence of
hepatitis C infection among Brazilian hemodialysis patients in Rio de Janeiro: a
one-year follow-up study. Rev Inst Med Trop. v. 37, n. 1, p. 75-9,
1995. Available at:
<http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46651995000100012>.
Accessed on: April 3, 2014.
http://www.scielo.br/scielo.php?script=s...
).
This demonstrates the importance of public health strategies, as anti-HCV screening by
the nucleic acid test (NAT) in blood donors, and recommendations for prevention and
control of hepatitis C at dialysis units, as well as guidance on the reuse of dialyzers,
now converted to single use according to a resolution of the National Agency of Sanitary
Surveillance (ANVISA), RDC nº. 11, of March 11, 2014(22 BRASIL. ANVISA. Agência Nacional de Vigilância Sanitária. Resolução RDC
nº 11, de 13 de março de 2014. Dispõe sobre os requisitos de boas práticas de
funcionamento para os serviços de diálise e dá outras providências. Available at:
<http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=14/03/2014&jornal=1&pagina=41&totalArquivos=164>.
Accessed on: April 3, 2014.
http://pesquisa.in.gov.br/imprensa/jsp/v...
,55 CARNEIRO, M. A. et al. Decline of hepatitis C infection
in hemodialysis patients in Central Brazil: a ten years of surveillance. Mem
Inst Oswaldo Cruz, v. 100, n. 4, p. 345-9, 2005. Available at:
<http://memorias.ioc.
fiocruz.br/issues/past-issues/item/527-prevalence-genotypes-and-riskfactors-associated-with-hepatitis-c-virus-infection-in-hemodialysispatients-in-campo-grande-ms-brazil>.
Accessed on: April 3, 2014.
http://memorias.ioc.fiocruz.br/issues/pa...
,77 DI LALLO, D. et al. Risk factors of hepatitis C virus
infection in patients on hemodialysis: a multivariate analysis based on a dialysis
register in Central Italy. Eur J Epidemiol, v. 15, n. 1, p. 11-4,
1999. Available at: <http://link.springer.com/article/10.1023/A:1007592912010>.
Accessed on: April 3, 2014.
http://link.springer.com/article/10.1023...
,88 ESPINOSA, M. et al. Marked reduction in the prevalence
of hepatitis C virus infection in hemodialysis patients: causes and consequences.
Am J Kidney Dis, v. 43, n. 4, p. 685-9, 2004. Available at:
<http://www.ajkd.org/article/S0272-6386%2804%2900011-3/abstract>. Accessed on:
April 3, 2014.
http://www.ajkd.org/article/S0272-6386%2...
,1111 JADOUL, M. Epidemiology and mechanisms of transmission of the hepatitis
C virus in haemodialysis. Nephrol Dial Transplant, v. 15, suppl. 8,
p. 39-41, 2000. Available at:
<http://ndt.oxfordjournals.org/content/15/suppl_8/39.short>. Accessed on: April
3, 2014.
http://ndt.oxfordjournals.org/content/15...
,1414 MELLO, L. A. et al. Soroprevalência da hepatite C em
pacientes hemodialisados. Rev Soc Bras Med Trop, v. 40, n. 3, p.
290-4, 2007. Available at:
<http://www.scielo.br/scielo.php?pid=s003786822007000300008&script=sci_arttext>.
Accessed on: May 17, 2012.
http://www.scielo.br/scielo.php?pid=s003...
).
In summary, the obtained results showed a decreased prevalence of hepatitis C when in
comparison to studies from the latest years, yet this prevalence is still very high if
contrasted with the 1.38% of the general population33 BRASIL. Ministério da Saúde. Boletim Epidemiológico de Hepatites Virais
2012. Publicado em 2012. Available at:
<http://www.aids.gov.br/publicacao/2012/boletim-epidemiologico-de-hepatites-virais-2012>.
Accessed on: May 10, 2013.
http://www.aids.gov.br/publicacao/2012/b...
.
Thus, rigorous observance of universal precaution guidelines is necessary to reduce transmission of HCV infection in hemodialysis units. Among the processes are the correct and rigorous disinfection of machines and equipment, precautions for the reuse of dialyzers, and an effective biosecurity control by the health staff. It is very important to keep rigorous screening control on the use of blood components, for instance, the employment of techniques such as NAT, aiming at improving sensitivity in the identification of HCV and HIV infections. We also highlight the necessity of early diagnosis in primary attention, and of health policies designed to track and monitor cases of hepatitis C in the general population.
Besides, a prospective follow-up of hemodialysis patients is also essential so as to identify the actual risk factors for contamination by this disease.
REFERENCES
-
1BARROS, E. et al Nefrologia: rotinas, diagnóstico e tratamento 3. ed. Porto Alegre, RS: Artmed, 2006.
-
2BRASIL. ANVISA. Agência Nacional de Vigilância Sanitária. Resolução RDC nº 11, de 13 de março de 2014. Dispõe sobre os requisitos de boas práticas de funcionamento para os serviços de diálise e dá outras providências. Available at: <http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=14/03/2014&jornal=1&pagina=41&totalArquivos=164>. Accessed on: April 3, 2014.
» http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=14/03/2014&jornal=1&pagina=41&totalArquivos=164 -
3BRASIL. Ministério da Saúde. Boletim Epidemiológico de Hepatites Virais 2012. Publicado em 2012. Available at: <http://www.aids.gov.br/publicacao/2012/boletim-epidemiologico-de-hepatites-virais-2012>. Accessed on: May 10, 2013.
» http://www.aids.gov.br/publicacao/2012/boletim-epidemiologico-de-hepatites-virais-2012 -
4CALLEGARI-JACQUES, S. M. Bioestatística: princípios e aplicações Porto Alegre, RS: Artmed, 2007.
-
5CARNEIRO, M. A. et al Decline of hepatitis C infection in hemodialysis patients in Central Brazil: a ten years of surveillance. Mem Inst Oswaldo Cruz, v. 100, n. 4, p. 345-9, 2005. Available at: <http://memorias.ioc. fiocruz.br/issues/past-issues/item/527-prevalence-genotypes-and-riskfactors-associated-with-hepatitis-c-virus-infection-in-hemodialysispatients-in-campo-grande-ms-brazil>. Accessed on: April 3, 2014.
» http://memorias.ioc.fiocruz.br/issues/past-issues/item/527-prevalence-genotypes-and-riskfactors-associated-with-hepatitis-c-virus-infection-in-hemodialysispatients-in-campo-grande-ms-brazil> -
6CARNEIRO, M. A. S. et al Hepatitis C prevalence and factors in hemodialysis patients in Central Brazil: a survey by polymerase chain reaction and serological methods. Mem Inst Oswaldo Cruz, v. 96, n. 6, p. 765-9, 2001. Available at: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762001000600003&lng=pt>. Accessed on: April 3, 2014.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762001000600003&lng=pt -
7DI LALLO, D. et al Risk factors of hepatitis C virus infection in patients on hemodialysis: a multivariate analysis based on a dialysis register in Central Italy. Eur J Epidemiol, v. 15, n. 1, p. 11-4, 1999. Available at: <http://link.springer.com/article/10.1023/A:1007592912010>. Accessed on: April 3, 2014.
» http://link.springer.com/article/10.1023/A:1007592912010 -
8ESPINOSA, M. et al Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis, v. 43, n. 4, p. 685-9, 2004. Available at: <http://www.ajkd.org/article/S0272-6386%2804%2900011-3/abstract>. Accessed on: April 3, 2014.
» http://www.ajkd.org/article/S0272-6386%2804%2900011-3/abstract -
9GOMES, M. et al Prevalência da soropositividade do anti-HCV em pacientes dialisados. Rev Saúde Públ, v. 40, n. 5, p. 931-4, 2006. Available at: <http://www.scielo.br/pdf/rsp/v40n5/26.pdf>. Accessed on: June 21, 2012.
» http://www.scielo.br/pdf/rsp/v40n5/26.pdf -
10HINRICHSEN, H. et al Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Liver Disease, v. 51, n. 3, p. 429-33, 2002. Available at: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773370/>. Accessed on: April 3, 2014.
» http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773370/ -
11JADOUL, M. Epidemiology and mechanisms of transmission of the hepatitis C virus in haemodialysis. Nephrol Dial Transplant, v. 15, suppl. 8, p. 39-41, 2000. Available at: <http://ndt.oxfordjournals.org/content/15/suppl_8/39.short>. Accessed on: April 3, 2014.
» http://ndt.oxfordjournals.org/content/15/suppl_8/39.short -
12KIRSZTAJN, G. M. Diagnóstico laboratorial em Nefrologia São Paulo, SP: Sarvier, 2010.
-
13LEÃO, J. R.; PACE, F. H. L.; CHEBELI, J. M. F. Infecção pelo vírus da hepatite C em pacientes em hemodiálise: prevalência e fatores de risco. Arq Gastroenterol, São Paulo, v. 47, n. 1, p. 28-34, 2010. Available at: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032010000100006>. Accessed on: May 17, 2012.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032010000100006 -
14MELLO, L. A. et al Soroprevalência da hepatite C em pacientes hemodialisados. Rev Soc Bras Med Trop, v. 40, n. 3, p. 290-4, 2007. Available at: <http://www.scielo.br/scielo.php?pid=s003786822007000300008&script=sci_arttext>. Accessed on: May 17, 2012.
» http://www.scielo.br/scielo.php?pid=s003786822007000300008&script=sci_arttext -
15NEUMANN, A. U. et al Hepatitis C viral dynamics in vivo and the antiviral efficacy of interferon-alpha therapy. Science, v. 282, n. 5386, p. 103-7, 1998. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/9756471>. Accessed on: May 17, 2012.
» http://www.ncbi.nlm.nih.gov/pubmed/9756471 -
16SALAMA, G. et al Hepatitis C virus infection in French hemodialysis units: a multicenter study. J Med Virol, v. 61, n. 1, p. 44-51, 2000. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/10745231>. Accessed on: April 3, 2014.
» http://www.ncbi.nlm.nih.gov/pubmed/10745231 -
17SESSO, R. C. C. et al Diálise crônica no Brasil − relatório do Censo Brasileiro de Diálise. J Bras Nefrol, São Paulo, v. 34, n. 3, p. 272-7, 2012. Available at: <http://www.jbn.org.br/detalhe_artigo.asp?id=1483>. Accessed on: December 10, 2012.
» http://www.jbn.org.br/detalhe_artigo.asp?id=1483 -
18SESSO, R. C. C. et al Resultados do Censo de Diálise da SBN. J Bras Nefrol, v. 29, n. 4, p. 197-202, 2007. Available at: <http://www.jbn.org.br/detalhe_artigo.asp?id=128>. Accessed on: June 30, 2012.
» http://www.jbn.org.br/detalhe_artigo.asp?id=128 -
19VANDERBORGHT, B. O. M. et al High prevalence of hepatitis C infection among Brazilian hemodialysis patients in Rio de Janeiro: a one-year follow-up study. Rev Inst Med Trop. v. 37, n. 1, p. 75-9, 1995. Available at: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46651995000100012>. Accessed on: April 3, 2014.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46651995000100012 -
20YONEMURA, K. et al High prevalence of hepatitis C virus antibody in patients with chronic renal failure at the start of hemodialysis therapy. Nephron, v. 73, n. 3, p. 484-5, 1996. Available at: <http://www.karger.com/Article/Pdf/189117>. Accessed on: April 3, 2014.
» http://www.karger.com/Article/Pdf/189117
Publication Dates
-
Publication in this collection
Sep-Oct 2014
History
-
Received
03 Jan 2014 -
Reviewed
15 Aug 2014 -
Accepted
07 Sept 2014