Hepatitis B virus infection in hemodialysis: recent discoveries

Controlling the spread of HBV infection in dialysis units has been one of the major advances in the treatment of patients with ESRD. The frequency of HBsAg carriers on maintenance dialysis is low in developed countries. However, prevalence and incidence rates of HBV infection among dialysis patients in less developed countries remain very high. Patients on maintenance dialysis and chronic HBsAg carriage are typically anicteric and rarely develop symptoms of hepatitis. The relationship between HBsAg and aminotransferase activity in dialysis population is stronger than has so far been recognized. HBsAg positivity is significantly associated with hepatocellular damage in dialysis patients. Aminotransferase activity in dialysis population is usually depressed; this hampers the recognition of HBV-related liver disease among dialysis patients by biochemical tests. The HBV viral load in HBsAg positive patients is low and stable over time; the low mortality attributable to liver disease in dialysis patients could be related to this finding. Numerous assays for detecting HBV DNA in serum of dialysis patients are available; they should not be used for purposes of routine screening within dialysis units. Continued implementation of the long-recommended infection control procedures against HBV within dialysis units is strongly suggested.