Management strategy of prevention and control of nosocomial infection of COVID-19 in blood purification center

There are many patients in the blood purification center who need maintenance hemodialysis to maintain life. Those patients generally havelow resistance and are easily exposed to coronavirus because they go back and forth the hospital and residence three times a week andclosely contact with family, caregivers, community personnel, people in various means of transportation, medical staff, and other patientsvisiting hospital. Therefore, the blood purification center has become a high‑risk environment for the spread of COVID-19 infection. In viewof this, our center quickly responded to the formulation and implementation of infection prevention and control measures suitable for thecharacteristics of the blood purification center and continuous renal replacement therapy (CRRT) emergency plan for fever and suspectedpatients. According to these measures, we have a positive effect on preventing and controlling nosocomial infection in the blood purificationcenter.

Intervention control of aerobic exercise in maintaining quality of life and pulmonary hypertension in hemodialysis patients

BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.AIM To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.METHODS 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected.Patients are divided into two groups,37 cases in the control group(group C)and 36 cases in the intervention group(group I).Patients are divided into two groups,group C is treated with oral administration of betaglandin sodium combined with routine nursing care.Based on group C,group I conducts power cycling exercises.RESULTS After treatment,group I patients had higher muscle strength,36-Item Short Form Health Survey scores,and Kidney Disease Targets Areas scores;The 6-minute walk distance test index level was higher and the Borg score was lower;The group I had lower systolic blood pressure,greater vital capacity,higher positive emotion,lower systolic pulmonary artery pressure index level,higher arterial partial oxygen pressure level,lower pulmonary vascular resistance index level,and higher blood oxygen saturation level[158.91±11.89 vs 152.56±12.81,1795.01±603.18 vs 1907.20±574.15,24.00(22.00,29.00)vs 24.00(22.00,28.00),P<0.001].CONCLUSION Aerobic exercise combined with Western medicine treatment can effectively improve patients'pulmonary hypertension,alleviate their negative emotions,and enable them to achieve a higher level of quality of life.

Fresh Processing Technology in Polygonatum odoratum Production Area and Its Comparison with Traditional Processing

[Objectives]To compare the effects of traditional processing and fresh processing on the quality of Polygonatum odoratum decoction piece.[Methods]The effects of fresh processing and traditional processing on the quality of P.odoratum decoction piece were compared and analyzed with appearance characteristics,total ash content,extract content,total polysaccharides content,and total flavonoids content as the evaluation indexes.[Results]Fresh processing method in different production areas has different effects on P.odoratum decoction piece.P.odoratum was dried in oven of 50℃.When moisture content was 41.44%-59.67%,it was cut.After complete drying at 50℃,the moisture content of dried P.odoratum was 8.94%-9.60%,and ethanol-soluble extract content was 77.29%-78.20%,and water-soluble extract was 77.7%-78.14%.At this time,the appearance characteristics of section of P.odoratum decoction piece were better than that of traditional processing,which was yellowish white.The total polysaccharide content was higher than that of traditional processing,and the content of total flavonoids was statistically significant different from that of traditional processing.[Conclusions]The quality of P.odoratum decoction piece by fresh processing is better than that of the traditional processing,and it is feasible to use fresh processing.

Identification of the risk of breast cancer in patients suffering from endometriosis:A meta-analysis

Background:Breast cancer and endometriosis are two significant diseases that threaten the health of female worldwide.The relationship between them is still in a state of controversy.In present study,we identified the risk of breast cancer in patients with endometriosis through a meta-analysis.Methods:A systematic search of the PubMed,Embase and Cochrane Library,with the terms for endometriosis,breast and cancer,tumor,neoplasm,or carcinoma combined.Studies on related risk estimates of endometriosis and breast cancer were included in the meta-analysis.Furthermore,a series of analytical methods such as sensitivity analysis,the Cochran Q test,Begg’s and Egger’s test were used to analyze the information of collected studies.Results:Finally,a total of 8 studies were included.After statistical analysis based on STATA software,the combined odds ratio of the results was 1.13(95%CI:1.09–1.17).And the results of subgroup analysis showed that the odds ratio values of different outcome indexes were 1.06(95%CI:1.02–1.09,P<0.05),the effective effect estimates were presented in SIR(P=0.006,I^(2)=80.3%).Conclusion:In present study,we identified that patients with endometriosis have an increased risk of breast cancer.It is worth considering that our research was a summary analysis of epidemiological data.More in-depth studies are needed to determine the pathophysiology of this relationship.

Preoperative risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy

AIM： To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation （OLT）. METHODS： Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system （MARS） as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality （30 d） after OLT. RESULTS： In the 50 patients, the statistically significant improvement in the biochemical parameters was observed （pre-treatment and post-treatment）. Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30d observation was： 28 kept alive and 6 patients died. CONCLUSION： Pre-operative SOFA, level of creatinine, INR, TNF-α, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantion can relieve these factors significantly.

Dexamethasone suppresses DU145 cell proliferation and cell cycle through inhibition of the extracellular signal-regulated kinase 1 /2 pathway and cyclin D1 expression

Aim： To determine the mechanisms of glucocorticoids in inhibiting advanced prostate cancer growth. Methods： The cell proliferation and cell cycle of prostate cancer DU145 cells following dexamethasone treatment were determined by proliferation assay and fluorescence-activated cell sorter. Western blot analysis was carried out to evaluate the effects of dexamethasone on phosphorylation of extracellular signal-regulated kinase （ERK）1/2 and expression of cyclin D1 in DU145 cells with or without glucocorticoid receptor （GR） antagonist RU486. Reverse transcription- polymerase chain reaction verified the expression of GR mRNA in DU145 cells. Results： Dexamethasone significantly inhibited DU 145 cell proliferation at the G0/G1 phase. Westem blot analysis showed a dramatic reduction of ERK1/2 activity and cyclin D1 expression in dexamethasone-treated cells. The decreased phosphorylation of ERK1/2 in dexamethasone-treated cells was attenuated by GR blockade. Additionally, the effects of dexamethasone in inhibiting cyclin D1 expression were altered by GR blockade. Conclusion： Dexamethasone suppresses DU145 cell proliferation and cell cycle, and the underlying mechanisms are through the inhibition of phosphorylation of ERK1/2 and cyclin D1 expression. The inhibition of ERK1/2 phosphorylation and cyclin D1 expression is attenuated by GR blockade, suggesting that GR regulates ERK1/2 and cyclin D1 pathways. These observations suggest that dexamethasone has a potential clinical application in prostate cancer therapy.

Efficacy of roxadustat in treatment of peritoneal dialysis patients with renal anaemia

BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1,2019 to June 30,2020 were selected.A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin(EPO)and roxadustat.RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included.Haemoglobin(Hb)levels were maintained or increased in all patients(100%),and no patients had a decrease in Hb compared with the previous phase.Patients had a mean Hb of 86.2±14.8 g/L with Hb compliance(Hb≥110 g/L)of 16.1%during the EPO phase and a mean Hb of 112.4±18.5 g/L with Hb compliance of 67.7%during the roxadustat phase.No major adverse cardiovascular events occurred in any patient.CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.

Application of nursing sensitive indicators in improving the quality of hemodialysis

To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December 2016 served as observation group.Another 40 outpatients who received dialysis from January 2015 to December 2015were selected as control group.Patients in control group received routine nursing and health education on hemodialysis,and those in observation group were given interventions based on nursing sensitive indicators.The hemodialysisrelated nursing sensitive indicators and satisfactory degree of patients on nursing service were compared between two groups.Results Observation group had a better outcome of hemodialysis nursing sensitive indicators compared with control group(observation group:Kt/V[1.30±0.06],Hb[115.0±4.8]g/L,serum Ca[2.31±0.06]mmoL/L,serum P[1.75±0.18]mmoL/L,product of Ca and P[30.95±0.58]mg2/dl,PTH[305±65]pg/mL.control group:Kt/V[1.18±0.07],Hb[99.0±5.2]g/L,serum Ca[2.52±0.07]mmoL/L,serum P[2.07±0.21]mmoL/L,product of Ca and P[39.75±0.74]mg2/dl,PTH[420±84]pg/mL.P<0.05 respectively.)The satisfactory degree of patients on nursing service was97.5%(39/40)in observation group and 80.0%(32/40)in the control group,with a significant difference(P<0.05).Conclusion Hemodialysis-related nursing sensitive indicators provide a scientific basis for nursing quality improvement in patients with hemodialysis,and also play a certain role in promoting high quality nursing service.

Analysis and Nursing Health Education of Current Status of Maintenance Hemodialysis Patients with Hyperphosphatemia

Concerned about the current situation of hemodialysis patients'awareness of the problems related to dialysis complicated with hyperphosphatemia,further analyze the existing problems and causes,give targeted and individualized health education,improve the compliance of diet,medication and self-management,strengthen nurse-patient communication,establish a good nurse-patient relationship,reduce and control the incidence of hyperphosphatemia,improve patients'quality of life,and improve prognosis.

Research Progress on the Biological Activity of Pectolinarigenin

Pectolinarigenin is a kind of flavonoid,which is an active ingredient in Eupatorium odoratum.Some studies have confirmed that pectolinarigenin has many biological activities,including anti-oxidation,anti-allergy,anti-inflammation,anti-tumor and so on.In this paper,the biological activity and related mechanism of pectolinarigenin were summarized in order to provide theoretical basis and reference for the further development and utilization of pectolinarigenin.

Effect of continuous low effective dialysis combined with hemoperfusion on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury

Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.

Effect of adjuvant levocarnitine therapy on EPO resistance, oxidative stress response and inflammatory response in patients with hemodialysis

Objective: To study the effect of adjuvant levocarnitine therapy on EPO resistance, oxidative stress response and inflammatory response in patients with hemodialysis. Methods: A total of 78 patients who received maintenance hemodialysis in Beijing Chaoyang District Shuangqiao Hospital between May 2015 and October 2016 were selected and randomly divided into two groups, the levocarnitine group received levocarnitine combined with conventional anemia correction therapy, and the control group accepted routine anemia correction therapy. The extent of EPO resistance, oxidative stress response and inflammatory response in two groups of patients were assessed before treatment as well as 3 months and 6 months after treatment. Results: 3 months and 6 months after treatment, the rhuEPO dosage and ERI, Nrf-2 , ARE, HO-1 and NQO-1 expression in peripheral blood mononuclear cells as well as AOPP, 8-OHdG, MDA, MCP-1, sICAM-1, PTX3, IL-4 and IL-10 levels in serum of levocarnitine group had been gradually decreasing while the rhuEPO dosage and ERI, Nrf-2, ARE, HO-1 and NQO-1 expression in peripheral blood mononuclear cells as well as AOPP, 8-OHdG, MDA, MCP-1, sICAM-1, PTX3, IL-4 and IL-10 levels in serum of control group were without significant change. Conclusion: Adjuvant levocarnitine therapy can significantly improve the EPO resistance, oxidative stress response and inflammatory response in patients with hemodialysis.

Development of Medication Literacy Scale for Pediatric Population with Nephrotic Syndrome and Assessment on Reliability and Validity

Objective:To develop a medication literacy scale for the pediatric population with nephrotic syndrome(NS)in order to evaluate its reliability and validity.Methods:According to the medication belief scale,specific medication beliefs,and self-set dimensions,the NS pediatric population health literacy scale was designed to evaluate the medication literacy of 120 children with NS.Items,homogeneity,reliability,and validity of the scale were analyzed.Results:There were statistically significant differences in the Levene F test between the top 27%and the last 27%of the 22 items(P<0.001).The differences in the t-test were statistically significant(P<0.001).Content validity I-CVI:after deletion of item 4,the I-CVI of other items were all higher than 0.91.S-CVI was higher than 0.80,and S-CVI/AVE was higher than 0.90.The internal consistency coefficient(Cronbach'sα)was 0.868.Structural validity:KMO(Kaiser-Meyer-Olkin)statistical value was 0.862,and Bartlett's spherical test value was 1578.172(P<0.001).The extracted 6 common factors explain 70.21%of the variance variation.The loads of 22 items on their main factors are all greater than 0.427 except items 2 and 5.Conclusion:The medication literacy scale for the NS pediatric population has proved its good practicability,but some items of cognition need to be further explored.

Liver support therapy with molecular adsorbents recirculating system in liver failure： a summary of 252 cases from 14 centers in China

Background A liver support therapy, named molecular adsorbents recirculating system （MARS）, has been used for more than 700 liver failure patients in China. We made here a summary to evaluate the effects of MARS treatment in different applications with emphasis on hepatitis B virus （HBV） based liver failure. Methods This report analyzed data of 252 patients （mean age （44.9±12.7） years） in three groups： acute severe hepatitis （ASH）, subacute severe hepatitis （SSH） and chronic severe hepatitis （CSH）. The largest group was CSH （156 patients, 61.9%）, and 188 patients （74.6%, 188/252） were infected with HBV. Results MARS treatments were associated with significant reduction of albumin bound toxins and water-soluble toxins. Most of the patients showed a positive response with a significant improvement of multiple organ function substantiated by a significant increase in prothrombin time activity （PTA） and median arterial pressure （MAP）. There was a decrease in hepatic encephalopathy （HE） grade and Child-Turcotte-Pugh （CTP） scale. Thirty-nine of 188 HBV patients （20.7%） dropped out of the commendatory consecutive therapy ending with lower survival of 43.6% while the rest of the 149 patients had a survival rate of 62.4%. Survival within the ASH and SSH groups were 81.2% and 75.0%, respectively. In the CSH group, end stage patients were predominant （65/151,43%）, whereas the early and middle stage patients had a better prognosis： early stage survival, including orthotopic liver transplantation （OLT） survival of 91.7%, middle stage survival of 75%, end stage survival of 33.8%. Conclusions MARS continues to be the most favorable extracorporeal treatment for liver support therapy in China for a wide range of conditions, including the majority of hepatitis B related liver failure conditions. The appropriate application of MARS for the right indications and stage of hepatic failure, as well as the fulfillment of prescribed treatments, will lead to the optimal therapeutic result.

Risk factors of hemodialysis catheter-related bloodstream infection and prediction model

Objective To investigate the risk factors for catheter-related bloodstream infection (CRBSI) in hemodialysis (HD) patients with tunnel-cuffed catheter (TCC)and construct a risk prediction model for the prevention and treatment of catheter infection.Methods It was a retrospective study. Patients who had their TCC removed in Hemodialysis Access Center of the First Affiliated Hospital of Zhengzhou University from July to December2020 were randomly divided into a training set (for model building) and a validation set (for model validation)in the ratio of 7:3.

Salmon calcitonin in prevention of osteoporosis in maintenance dialysis patients

Background Renal osteodystrophy is one of the commonest complications of chronic renal failure. It may have a severe impact on the quality of life of patients on maintenance dialysis therapy. Besides post-menopausal women and elderly people, the dialysis patients are another high risk group. But at present, there is no research on how to prevent osteoporosis in maintenance dialysis patients. This study was conducted to observe the bone density of maintenance dialysis patients and to evaluate the clinical outcomes and safety of different administration dosage of salmon calcitonin to prevent osteoporosis in maintenance dialysis patients. Methods One hundred and forty-eight patients on maintenance dialysis were involved in the 12-month, randomized, controlled trial. Fifty patients （experiment I group） received subcutaneous injection of salmon calcitonin （50 U） three times a week for 12 months. Fifty patients （experiment II group） received subcutaneous injection of salmon calcitonin （100 U） three times a week for 12 months. At the same time, both of them received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 pg qn for 12 months. The control group only received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The levels of bone mass density （BMD） of the lumbar spine and femoral neck, serum intact parathyroid hormone （iPTH）, osteocalcin （OC）, calcium, phosphorus, alkaline phosphatase （ALP） were assessed at baseline and then again after 3, 6 and 12 months of treatment. Results The values of BMD at the lumbar spine and femoral neck before the treatment were not significantly different from those 3, 6, and 12 months after the treatment in trial groups I and II （all P 〉0.05） and there were no significant differences in the BMD values at different time points between trial groups I and II. In the control group, the BMD values at the lumbar spine and femoral neck 3, 6, and 12 months after the beginning of trial were significantly lower than those before the trial, and significantly lower than the corresponding values of trial groups I and II （all P 〈0.05）. The serum OC 3, 6, and 12 months after the treatment was significantly lower than that before the experiment （all P 〈0.05） in the control group. However, there was no significant difference in the value of serum OC before and 3, 6, and 12 months after the treatment in trial groups land II （all P 〉0.05）. Conclusions The dose of salmon calcitonin 50 U three times a week plus calcium carbonate and active vitamin D can effectively preserve the BMD and prevent bone loss in maintenance dialysis patients, and it is well tolerated by patients on maintenance dialysis.

Thrombosis of the superior vena cava and auxiliary branches in patients with indwelling catheterization of the internal jugular vein

Background Central venous thrombosis is a serious and life-threatening complication in hemodialysis （HD） patients with an indwelling catheter. The present study aimed to investigate the prevalence and characteristics of thrombosis of the superior vena cava and auxiliary branches in Chinese HD patients with an indwelling internal jugular venous catheter and to explore its risk factors.Methods Fifty-four patients on maintenance hemodialysis （MHD） with an indwelling catheter were enrolled in this cross-sectional study. The thrombosis of the internal jugular vein, subclavical vein, brachiocephalic vein and superior vena cava was assessed by vascular ultrasound. Collected were data on age, gender, ultrafiltration volume, Kt/V, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium, and phosphorus, and parathyroid hormone.Results The patients were given short-or long-term double lumen central venous catheters. Among them, 42 patients had the catheter placed into the right internal jugular vein, and 12 patients into the left internal jugular vein. Different degrees of central venous thrombosis were found in 33 patients （61.1%）. The prevalence of thrombosis in the jugular vein, brachiocephalic vein, subclavical vein and superior vena cava was 61.1% （33/54）, 44.4% （24/54）, 16.7% （9/54） and 5.6% （3/54）, respectively. Among the 33 HD patients with central venous thrombosis, the percentages for one, two, three and four affected veins were 27.3% （9/33）, 45.4% （15/33）, 18.2% （6/33） and 9.1% （3/33）, respectively. Twelve （12/33, 36.4%） of the 33 HD patients with central venous thrombosis had clinical symptoms. Nine patients （27.3%） had edema of the upper extremity and 3 （9.1%） had new-onset symptoms of pulmonary embolism such as cough, chest distress and short breath. The incidences of diabetes mellitus and malignant tumor and levels of lipoprotein a and homocysteic acid were significantly higher in the HD patients with central venous thrombosis than in those without central venous thrombosis. Logistic regressive analysis revealed that high level of homocysteic acid was the important risk factor for central venous thrombosis in HD patients with indwelling catheterization of the internal jugular vein.Conclusions The prevalence of central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein is quite high, especially in those patients with diabetes mellitus, malignant tumor, high levels of serum lipoprotein and homocysteic acid. Its clinical symptoms are insidious but dangerous. High level of homocysteic acid may be the important risk factor for central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein.

Hepatitis C viral infection in a Chinese hemodialysis unit

Background The prevalence of hepatitis C virus （HCV） infection among maintenance hemodialysis （MHD） patients varies among countries and among dialysis units within a single country. The present study aimed to investigate the prevalence and characteristics of HCV infection in MHD patients in a Chinese hemodialysis unit.Methods One hundred and ninety-two patients on MHD for an average of （86.1±30.0） months （range 6-181 months） were enrolled in this cross-sectional study. HCV antibody and HCV-RNA were measured in these MHD patients before hemodialysis by enzyme-linked immunosorbent assay （ELISA） and polymerase chain reaction （PCR） methods.According to the result, all the patients were then divided into two groups： GroupⅠwas positive for HCV antibody and/or HCV-RNA （n=32）, and Group Ⅱ was negative for HCV antibody and HCV-RNA （n=160）. The following information was obtained for all the patients： socio-demographic data, history of blood transfusions and kidney transplantation, and some laboratory values. The MHD patients who were positive for HCV antibody and/or HCV-RNA were followed for more than three years. The disease activities were graded into ＂asymptomatic＂ if alanine aminotransferase （ALT） was less than 40 U/L,＂low activities＂ if ALT was 40-79 U/L, and ＂high activities＂ if ALT was equal to or above 80 U/L.Results The prevalence of HCV infection in MHD patients in our dialysis unit in May 2009 was 16.7, which was significantly higher than in general population （3.2%）. Among the 32 MHD patients with HCV positive, 20 patients were positive for HCV antibody but negative for HCV-RNA, eight patients were positive both for HCV antibody and HCV-RNA,four patients were negative for HCV antibody but positive for HCV-RNA. Eleven patients had a history of kidney transplantation and 12 had a history of blood transfusion, which were significantly more than among the MHD patients without HCV. Thirty of the 32 MHD patients were asymptomatic. There were no significant differences in age, aspartate aminotransferase （AST）, ALT, or between HCV-RNA positive group and HCV-RNA negative group. But the dialysis duration in the HCV-RNA positive group was significantly longer than that in the HCV-RNA negative group. All the 20HCV-RNA negative patients were asymptomatic. Two of the 12 HCV-RNA positive patients had low activity. None of the 32 cases with HCV positive markers had cirrhosis.Conclusions A high prevalence of HCV infection in MHD patients is related to blood transfusion and kidney transplantation. Occult HCV infection is present in MHD patients. Chronic hepatitis C among MHD patients is mild in disease activity, and is not progressive, perhaps due to immunological abnormalities in these patients.