Hepatitis B virus (HBV)
infection persists among patients undergoing maintenance dialysis in the industrialized world. Knowledge of the epidemiology and the natural history of HBV
infection in dialysis patients has markedly improved but
antiviral therapy for
hepatitis B remains a significant challenge in this population. A variety of therapeutic options are now available for the treatment of
chronic hepatitis B, including potent new nucleos(t)ide analogues, along with standard and pegylated
interferon. The most extensive experience in the dialysis population has been with
lamivudine. Although several questions about
lamivudine use in dialysis patients remain unanswered, it has shown potent
antiviral activity: the range of clearance of HBV
viremia (HBV
DNA) from serum is between 56% and 100% in dialysis patients with
chronic hepatitis B. Its major limitation is emergence of resistance. Tolerance to conventional or pegylated
interferon monotherapy is poor in the dialysis population. There is limited data regarding
adefovir dipivoxil (ADV)
therapy in the dialysis population, while very little information is available about the use of the newer agents,
tenofovir and
entecavir, in patients with
renal failure. It is recommended that dialysis patients with persistent
HBsAg seropositive status be evaluated for
antiviral treatment and that the decision to treat be based on the potential benefits and risks of
therapy including life expectancy, candidacy for
kidney transplantation, and comorbidities.
Hepatitis B is relatively uncommon among patients undergoing dialysis in developed countries and this clearly hampers prospective clinical trials aimed to evaluate the efficacy and safety of
therapy with nucleos(t)ide analogues for
chronic hepatitis B in this population.