Hepatitis B viral infection in maintenance hemodialysis patients: A three year follow-up

Abstract

AIM:To observe the prevalence of hepatitis B virus (HBV) infection in maintenance hemodialysis patients. METHODS:Eighty-eight hemodialysis patients who had been receiving hemodialysis regularly for an average of 39.45 ± 7.57 (range from 36 to 49) mo were enrolled in this study. HBV markers were measured in these patients before hemodialysis and in 100 healthy controls by the chemiluminescent microparticle immunoassay (CMI) method in order to compare the incidence of HBV infection in hemodialysis patients versus normal healthy people. All patients were then divided into two groups: patients positive for HBV markers (i.e. those positive for HBsAg, anti-HBc, HBeAg, anti-HBe, with or without positive anti-HBs) (n = 33), and patients negative for HBV markers (including those only positive anti-HBs) (n = 55). The following information was obtained for all patients: socio-demographic data, number of blood transfusions and some laboratory investigations. After 39.45 ± 7.57 mo follow-up, HBV markers were measured in these patients by CMI. R E S U LT S :T h e i n c i d e n c e o f H B V i n f e c t i o n i n maintenance hemodialysis patients was 37.5%, which was higher than in controls (9%). In the patients positive for HBV markers, there were 13 patients (39.4%) who had a history of blood transfusion, which was more than the number [12 (21.8%), P = 0.04] of patients negative for HBV markers. Eight of the 88 patients negative for HBV markers turned out to be positive, while three of the 33 patients positive for HBV markers turned out to be negative. There was no cirrhosis of the liver or hepatoma occurring in these patients. CONCLUSION:Maintenance hemodialysis patients have a higher risk of HBV infection than the average population. The number of blood transfusions is associated with an increased prevalence of HBV. While it is hard for hemodialysis patients to eliminate HBV, the prognosis of patients with positive HBV markers is good.

Clinical significance of antibody to hepatitis B core antigen in multitransfused hemodialysis patients

“…[20] In this study positive anti-HBc was found in 44 patients (30.8%). Other studies by Gohar et al and Cendoroglo et al reported positive anti HBc in 51.8%, 55.7% of hemodialysis patients.…”

“…It has been suggested that the hemodialysis procedures lower HBV DNA level by various mechanisms: the clearance of HBV DNA by the dialysate, the entrapment of HBV DNA particles onto the membrane surface of dialyzers, and the production of cytokines and other substances during hemodialysis sessions. [20]…”

Spontaneous Clearance of Hepatitis B Surface Antigenemia After Long‐term Hemodialysis

“…Because of cellular immune status disturbances, some authors believe that dialysis patients cannot terminate HBsAg production, a marker of viremia. A review of the literature found only five reported cases of HBsAg seroconversion among chronic carrier dialysis patients .…”

“…They also demonstrate different disease manifestations compared with healthy individuals and are far more likely to progress to a chronic carrier state . There are only a few reports of spontaneous HBsAg clearance in HD patients with chronic HBV infection . We report a case where a HD patient with longstanding chronic HBV infection spontaneously seroconverted temporally related to a persistent arteriovenous graft (AVG) infection and we offer a hypothesis for why this may have occurred.…”

Hepatitis B Vaccination and Screening Awareness in Primary Care Practitioners

“…In dialysis patients the incidence and prevalence of HBV is high due to multiple parenteral exposures during dialysis and the immunosuppressed state associated with end stage renal disease [4, 16, 17]. Since 1982, HBV vaccination has been recommended for hemodialysis patients [18].…”