Hepatitis B Annual

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Year : 2006  |  Volume : 3  |  Issue : 1  |  Page : 76-105

Management of chronic hepatitis B infection in patients with end-stage renal disease and dialysis

Division of Nephrology, Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China

Correspondence Address:
Ping-Nam Wong
Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong, SAR
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Source of Support: None, Conflict of Interest: None

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Chronic hepatitis B virus (HBV) infection is an important issue among dialysis patients. It could result in nosocomial transmission and infection outbreaks in dialysis units. Vaccination, in addition to universal precautions, regular virologic screening and segregation policy, appear to be of paramount importance in the effective control of HBV infection in a hemodialysis unit, especially in view of the recent discovery of occult hepatitis B infection. Apart from infection control considerations, chronic HBV infection also poses particular problems to dialysis patients in terms of diagnosis and treatment of hepatic complications and pre-transplant management. This review summarizes the recent knowledge and understanding regarding the natural history, clinical presentation and outcome of chronic hepatitis infection in uremic patients and limitations of various existing diagnostic measures in the management of hepatic complications. It seems that chronic HBV infection is associated with high risk of hepatic complications in uremic individuals. Biochemical markers and HBV DNA are, however, inconclusive and liver biopsy remains the only definitive means to establish the activity of liver disease in dialysis patients. In this review, we propose an algorithm for approaching this group of patients and discuss the indications of liver biopsy, options of anti-viral therapy and pre-transplant workup in dialysis patients with chronic hepatitis B infection.

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