From the Guidelines
Prior to dialysis, a hepatitis B panel consisting of HBsAg, anti-HBs, and anti-HBc should be completed to determine a patient's hepatitis B status and guide infection control measures. This recommendation is based on the guidelines from the US Centers for Disease Control and Prevention (CDC) and the American Association for the Study of Liver Diseases, as outlined in a 2020 study published in the American Journal of Kidney Diseases 1. The panel is crucial for identifying patients with active infection, those who are immune due to vaccination or resolved infection, and those with previous or ongoing infection. Key components of the panel include:
- HBsAg to identify active hepatitis B infection
- Anti-HBs to indicate immunity from vaccination or resolved infection
- Anti-HBc to show previous or ongoing infection The interpretation of these tests is essential for implementing appropriate isolation procedures, vaccination strategies, and antiviral therapy in the dialysis unit, as detailed in the study 1. Regular monitoring, including monthly HBsAg testing for susceptible patients and periodic testing for all dialysis patients, is also necessary to prevent outbreaks in this vulnerable population, as recommended by the CDC and supported by the study 1.
From the Research
Hepatitis B Panel Prior to Dialysis
The hepatitis B panel that needs to be done prior to dialysis includes:
- HBsAg (Hepatitis B surface antigen)
- HBsAb (Hepatitis B surface antibody)
- Anti-HBc (Hepatitis B core antibody)
- HBeAg (Hepatitis B e-antigen)
- HBeAb (Hepatitis B e-antibody) As reported in a case study 2, a patient with all 5 positive serum markers, including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb, was admitted due to abnormal liver function.
Importance of Screening
Screening for hepatitis B is crucial for patients on dialysis, as they are at high risk of infection 3. A study found that 73.8% of dialysis patients were vaccinated against hepatitis B, but only 11 patients had prior dosage of anti-HBc. The study suggests that dosing of anti-HBc and anti-HBs before admission to dialysis is beneficial, but economic constraints may limit screening to only HBsAg.
Prevention and Treatment
Prevention and treatment of hepatitis B in patients on hemodialysis are essential 4. The study recommends strict adherence to standard infection prevention measures, continuous monitoring of HBV markers, patient and personnel immunization, and hepatitis B treatment in hemodialyzed patients. Each new patient in a dialysis center must be tested for HBV markers, and all patients should be routinely screened every 3-4 months.
Management of HBV Infection
The management of HBV infection in dialysis patients is critical 5. The study found that the rate of serum hepatitis B surface antigen (HBsAg) seropositivity in patients on maintenance hemodialysis is low, but outbreaks of acute HBV infection continue to occur. Updated recommendations for the management of HBsAg chronic carriers on maintenance dialysis have been issued.
Recent Discoveries
Recent discoveries have highlighted the importance of controlling the spread of HBV infection in dialysis units 6. The study found that 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 previously recognized.