Hepatitis B in Patients with End-Stage Renal Disease Undergoing Maintenance Hemodialysis

Despite all prevention methods, hepatitis B virus (HBV), which can cause acute and chronic hepatitis, cirrhosis and liver cancer, still has remained endemic in many areas and more than 350 million people are chronic carriers of this virus in the world. The incidence of hepatitis B infection has significantly decreased among the patients with end stage renal disease during the past few decades due to factors such as blood screening for HBsAg and anti-HBc, reducing the need for blood transfusion after the advent of erythropoietin, hepatitis B vaccination and the implementation of infection control measures in hemodialysis units. It seems that HBsAg test is sufficient for the diagnosis of HBV infection in most end stage renal disease (ESRD) patients. However since the biochemical tests often cannot be reliable to indicate the status of liver pathology, the liver biopsy is the best method to ascertain the activity of hepatitis and the degree of cirrhosis. It is often recommended when antiviral treatment is being considered and before kidney transplantation for assesses the activity of HBV-related liver disease. According to the side effects of interferon-alfa among dialysis patients, nucleoside analogs are better choices for the treatment of hepatitis B among these patients. Finally it should be noted that Entecavir is the recommended first-line oral medication for hepatitis B among these patients.