HCV due to Dialysis??


This is a graph showing the course of illness in the patient before he was referred to us.The patient in 2016 had fever for which he got all the routine investigations done and the reports were absolutely normal.In July,2017 he had fever and generalised body pains for which he was treated by a doctor at a local hospital. His fever subsided after 5 days but his body pains persisted for 2 months for which he used some medication for 1 month 15 days. After 2 months in september, 2017 he consulted the same doctor for persisting body pains. The doctor advised for few investigations for which the patient went to a hospital in hyderabad and got the tests done.Here they informed him that his kidney functioning wasn't good and his serum creatinine was 8.9 mg/dl and he needs to be initiated on Hemodialysis.(but the pt was completely asymptomatic except for his body pains).He underwent 2 cycles of Hemodialysis after which he got an Arteriovenous fistula done and then again 2 cycles of Hemodialysis done and the patient was discharged.The patient was advised for the need  of Hemodialysis further in future. He was then referred to hospital near hyd (near his living area so that he can visit regularly)in Oct 2017.



This slide shows the course of patient after coming to our hospital.In Oct, 2017 he came to us here he was admitted under arogyasree for Maintainence hemodialysis.From Oct, 2017 to Nov 2018 he was on regular maintainence hemodialysis, two times a week. In Nov, 2018 according to Arogyasree protocol the patient completed 10 HD on a case sheet, so he was discharged and then again advised for routine investigations for readmission.It was during this process that the patient HCV screening test turned out to be positive.The patient was asked to go to a centre where HD for a HCV patient isavailable as it is not done in our hospital as per the rules.




The Slide shows the trend of serum creatinine from nov 2017 to march 2018.During this period he was not on dialysis and he was completely asymptomatic


These are AP and lateral views of pt


This image shows AV fistula created in his non dominant handv during his 1st dialysis in sep 2017



This slide is showing the medications the patient has been using since he is diagnosed to be a CKD patient


The patients reports showing his HCV positivity, Anti HCV antibodies which is the screening test.




 This is the report of HCV RNA, viral load of the patient showing his active status

His LFT’s show raised SGOT and SGPT and bilirubin, ALP, albumin and protein are all normal



acoording to 'KDIGO' international guidelines it was given that its not necessary to isolate HCV pt's on HD provided we follow proper sterilization techniques. In our setting its better we isolate.

what is source of  HCV for this patient? Is it because of dialysis machine? dialysate? tubing?

what are the screeing and confirmatory tests done for HCV detection?

what is the sensitivity and specificity of the tests used for HCV detection?

why do we have to isolate HBsAg+ patients undergoing HD but not HCV pt's??
is it because of particle size??
what about HIV+ patients? do we need to isolate them as well?

what precautions are to be taken while dialysing so that we can prevent transmission of HCV?

now as one pt tested positive for HCV do we have to test all other pt's underwent dialysis in our centre? if so why? what are the conversion rates?

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