Hepatitis B virus infection in dialysis patients

Abstract

Hepatitis B virus (HBV) infection remains a major issue among dialysis patients. It is associated with a high risk of hepatic complication. The liver disease runs a unique clinical course in dialysis patients, as it can progress with modest hepatic inflammation and prominent fibrosis. The conventional cut-off level of serum alanine aminotransferase (ALT) for commencing antiviral therapy may prove too high and inappropriate for dialysis patients, and liver biopsy appears to be the only definitive means to establish the activity of liver disease in dialysis patients. Liver biopsy should be considered in patients with a serum ALT level that is persistently greater than 30 IU/L, or 0.75-fold the upper limit of the normal level, and/or other clinical and laboratory findings that suggest active liver disease. For antiviral treatment, preliminary reports have shown that lamivudine is effective and well tolerated in dialysis patients. However, the long-term efficacy of lamivudine and its optimal effective dose in dialysis patients remain unknown. The prevention of nosocomial transmission among dialysis patients is also important. Universal precaution measures should be strictly observed and the segregation of hepatitis B surface antigenpositive hemodialysis patients should be considered. For HBV non-immune patients, the importance of HBV vaccination should not be overemphasized. Until a new generation of highly immunogenic vaccines that are proven to be safe and effective in patients with end-stage renal disease becomes available, early vaccination before the development of end-stage renal failure remains the best way to secure immunological protection against HBV infection in dialysis patients.

Occult hepatitis B virus infection in hemodialysis patients in Recife, State of Pernambuco, Brazil

“…Jardim 19 Nonetheless, detecting such patients in hemodialysis clinics is of prime importance for avoiding dissemination of the virus inside these units, given that patients with unidentified occult HBV may transmit this infection to other patients as they undergo their treatment alongside other hemodialysis patients who are susceptible to HBV. The repeated exposure to body fluids during dialysis procedures predisposes dialysis patients to nosocomial transmission of HBV 25 . A molecular biological study on patients receiving treatment in the same hemodialysis units showed that there was relative homogeneity of HBV subtypes, which supports the notion that patient-to-patient transmission of HBV infection takes place in hemodialysis units 25 .…”

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients From Egypt With or Without Hepatitis C Virus Infection

“…in patients with ESRF undergoing dialysis has decreased significantly during the past few decades (1), it is still a distinct clinical problem, as the immunosuppressive nature of renal disease often leads to chronicity of the viral infection and results in an opportunity for nosocomial spread of the infection among dialysis patients (1)(2)(3)(4)(5). Occult HBV infection (OBI) is defined as the presence of a small amount of HBV in patients with serum that tests negative for hepatitis B surface antigen (HbsAg).…”

“…Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are well-known and important causes of liver disease in end-stage renal failure (ESRF) patients on hemodialysis (HD) (1)(2)(3)(4). Although the prevalence of HBV…”

Prevalence and Incidence of Hepatitis C Virus in Hemodialysis Patients in British Columbia: Follow‐up after a Possible Breach in Hemodialysis Machines

“…common than HCV in hemodialysis units (8)(9)(10)(11) due to routine screening, vaccination programs, infection control measures for HBV (12,13) and higher rates of viral clearance.…”