Risk Assessment Of HCV Infection In The Hemodialysis Clinic And Risk Factors Of HCV Infection In Hemodialysis Patients In Lanzhou

Objective To understand the current situation of dialysis services in hemodialysis clinics and the status of hepatitis C virus(HCV)infection in hemodialysis patients in Lanzhou,further conduct risk assessment of HCV infection in the hemodialysis clinic of Lanzhou and explore the risk factors of HCV infection in hemodialysis patients,then provide evidence for medical institution to formulate strategies to prevent and control HCV infection in hemodialysis population.Methods A questionnaire survey regarding hemodialysis services was conducted among 17 hemodialysis institutions in Lanzhou from October to November 2017.The data of hemodialysis equipment and medical personnel management,HCV infection of patient,isolation operation and disinfection of dialysis equipment were collected.Five indexes were selected and the variation coefficient was used to determine the index weight.According to the weight rank-sun ratio(WRSR),the risk assessment of HCV infection in 17 hemodialysis clinics of Lanzhou were conducted and the risk rating was defined according to the optimal grading principle.Five hemodialysis centers in Lanzhou were selected and a structure questionnaire survey was conducted in hemodialysis patients in hemodialysis center from April to July 2018.The data of socio-demographic characteristics,past diagnosis and treatment history,related factors of hemodialysis and serological test results of HCV were collected.Univariate analysis of HCV infection in hemodialysis patients and multivariate analysis using multistage generalized estimation equation(GEE)logistic regression model was conducted to explore the risk factors of HCV infection in hemodialysis patients.Result(1)The current situation of dialysis services in hemodialysis clinics and the status of HCV infection in hemodialysis patients in Lanzhou:there were 17hemodialysis centers of hospital providing hemodialysis services in Lanzhou and a total of 319 dialysis machines.The number of hemodialysis patients increased from661 in 2012 to 1321 in 2016 and roughly doubled;The annual number of hemodialysis patients increased from 65624 in 2012 to 135746 in 2016 and roughly doubled;The report HCV infection rate in hemodialysis patients decreased from 5.75%in 2012 to 3.79%in 2016;The five-year mean report HCV infection rate in dialysis patients was 4.28%.In the survey,there were 539 hemodialysis patients in 5hospitals,23 patients with positive anti-HCV,and the positive rate of anti-hcv was4.27%.(2)The result of risk assessment of HCV infection in the hemodialysis clinic of Lanzhou showed that there was a high correlation between WRSR and probability units(correlation coefficient r=0.981,linear regression equation:(2?=0.164*Y-0.311).Grading result showed Y1 and Y12 dialysis clinics had the low risk for HCV infection,Y3 dialysis clinic had the high risk and the others had the medium risk.(3)Risk factors of HCV infection in hemodialysis patients in Lanzhou:The results of univariate analysis showed that having those fectors of the history of transfusion during hemodialysis(?~2=9.862,P=0.002),history of using blood products(?~2=11.752,P=0.001),history of surgery(?~2=7.228,P=0.007),history of oral treatment(?~2=6.793,P=0.009)and history of acupuncture treatment(?~2=9.082,P=0.003)was associated with positive anti-hcv in dialysis patients.The results of GEE model indicated that history of transfusion during hemodialysis(OR=3.074,95%CI:1.391~6.787),history of using blood products(OR=3.108,95%CI:2.063~4.683),prolonged hemodialysis(OR=1.009,95%CI:1.000~1.019),history of oral treatment(OR=2.450,95%CI:1.452~4.137),history of acupuncture treatment(OR=3.755,95%CI:2.591~5.436)were the risk factors of HCV infection in hemodialysis patients.Education level in junior high school and below(OR=3.714,95%CI:2.983~4.623)was associated with HCV infection in dialysis patients.Conclusion(1)The scale of hemodialysis services in Lanzhou has been continuously expanded;The number of dialysis patients and the annual number of hemodialysis patients has increased by year;The report HCV infection rate in dialysis patients significantly decrease;Compared to the general population,the positive rate of anti-HCV of hemodialysis patients in Lanzhou was significantly higher.(2)The risk levels of HCV infection of hemodialysis clinics in Lanzhou are different and most of them are at the medium and low risk levels.(3)History of blood transfusion on hemodialysis,prolonged dialysis time,using blood products,oral treatment,acupuncture and low education level can significantly increase the infected risk of HCV.