Efficient Cytomegalovirus Detection AmongHaemodialysis Patients Through qPCR

Abstract

One of the leading causes of death in Hemodialysis (HD) patients is Cytomegalovirus
(CMV) infection. Quantitative PCR is considered as a highly sensitive method as it
detects small quantities of nucleic acid in various clinical samples. In Pakistan,
nephrology units are not well developed and the investigations involved in normal
encounter of viral infections in HD patients have been quite limited. Present study aimed
to determine the prevalence of CMV infection, by ELISA and qPCR in patients
undergoing HD, in nephrology units in Pakistan. In this cross-sectional study total 150
patients undergoing HD were included by non-probability convenience sampling
technique, and those undergoing peritoneal dialysis were excluded. Blood specimen was
collected to estimate Hb, TLC, PLT count, bilirubin total, AST, ALT, ALP, urea,
creatinine, uric acid and glucose levels. CMV IgM and IgG antibodies were detected by
ELISA method and CMV viral load by qPCR. Data was analyzed by using SPSS v.26.
Mean of age was found to be 42.28±13.63 years, CMV IgM antibodies level=323±210
AU/mL and CMV IgG antibodies level=311±182 AU/mL. Overall patients’ frequency of
male was 66.7% and of female was 33.3%. Frequency of patients with positive CMV IgM
level was 43.3%, positive CMV IgG level 72.0%, and positive for CMV viral load 82.7%.
Prevalence of CMV IgM infection was higher in younger age (45.1% vs. 40.7%), males
(45.0% vs. 40.0%), anemic males (46.0% vs. 38.5%), leukocytosis (55.6% vs. 50.0%),
thrombocytopenia (32.0% vs. 18.2%). Prevalence of CMV IgG infection was also higher
in younger age (74.7% vs. 67.8%), anemic males (73.6% vs. 61.5%), anemic females
(73.2% vs. 66.7%), and leukocytosis (80.0% vs. 75.0%). Prevalence of CMV viral load
was lower in younger age (81.3% vs. 84.7%, P-value 0.748); males (81.0% vs. 86.0%, Pvalue
0.593); non-anemic males (76.9% vs. 81.6%, P-value 0.708), leukocytosis (93.3%
vs. 100.0%, P-value 0.019), bilirubin total >1.0 (80.4% vs. 83.8%, and BSR (78.7% vs.
88.5%, P-value 0.177). The study concluded that prevalence of positive CMV viral load
was markedly higher than prevalence of CMV IgG positive cases and almost twice higher
than CMV IgM positive cases. Screening for CMV infection by commonly used ELISA
method may give false negative results. Therefore, patients undergoing HD should be
screened by quantitative PCR in future.