Hepatitis B virus (HBV) infection can lead to acute or chronic hepatitis, cirrhosis, or hepatocellular carcinoma. Despite the availability of effective vaccines since 1982, HBV infection has remained endemic in many localities, with more than 350 million chronic HBV carriers worldwide. (See "Clinical manifestations and natural history of hepatitis B virus infection" and "Epidemiology, transmission, and prevention of hepatitis B virus infection".)
HBV infection in dialysis patients presents a distinct clinical problem in view of the immunosuppressive effect of renal failure, the susceptibility for de novo infection and nosocomial transmission, the long-term implications on morbidity and mortality, and the change in clinical course after kidney transplantation. The natural history of HBV infection in dialysis patients may also vary according to the timing of infection, genotype, and thus locality.
In endemic areas, most adult dialysis patients with HBV infection are chronic carriers who acquired HBV infection during early childhood. By comparison, HBV infection in nonendemic areas is often acquired during adulthood. Dialysis patients are more prone to become chronic carriers, compared with patients without renal failure, due to their immunosuppressed state .
The majority of newly HBV-infected dialysis patients have a relatively mild clinical course . Infected patients are often asymptomatic and have normal or only slightly elevated serum transaminase levels. Data from patients on peritoneal dialysis showed that the impact of HBV infection per se on the survival of dialysis patients was relatively small .
By comparison, there is a significant risk of clinical deterioration in the HBV-infected renal transplant recipient. The risk of severe, life-threatening complications is highest when de novo HBV infection occurs shortly after transplantation, but hepatitic flares and liver-related complications can occur at any time after kidney transplantation in hepatitis B surface antigen (HBsAg)-positive kidney transplant recipients, including those who have been asymptomatic HBV carriers during dialysis [4-7]. Therefore, despite the relatively benign clinical disease in dialysis patients, the importance of preventing and treating HBV infection in dialysis patients must be underscored.