Hepatitis B Infection during Renal Replacement Therapy

Hepatitis B virus (HBV) infection in patients with end-stage renal disease (ESRD) on renal replacement therapy—hemodialysis and/or renal transplantation—usually has an unfavorable course with a tendency towards chronicity leading to increased morbidity and mortality (1). Furthermore, the patients with the infection remain a source of nosocomial infection during hemodialysis. Though the incidence of HBV infection in patients with ESRD has significantly decreased due to preventive measures like vaccination and obedience to universal precaution and isolation rules during dialysis, this infection still continues to occur during renal replacement therapy in many units in the world including India. Patients with ESRD remain at increased risk of contracting HBV because of increased exposure to blood products, shared hemodialysis equipment, frequent breaching of the skin, immunodeficiency of Chronic Kidney Disease (CKD), and continuing high prevalence rates of HBV infection among hemodialysis patients. The frequency of HBV seropositivity in renal replacement therapy in India had been reported from 4% to 44% (2-4). Higher frequencies are reported only from few units, while in most of the larger well-organized units, it is less than 5%. Patients with ESRD regularly get transplant unless they have significant histological fibrosis or clinically advanced liver disease. We had earlier reported that chronic liver disease, due to hepatitis, was the second most common cause of death in renal transplant patients in the second decade post-transplant (5).