Although the prevalence of
chronic hepatitis B virus (HBV)
infection in patients with
chronic kidney disease remains low in developed countries, clinicians should be aware of the rationale for treatment in this setting. This patient population presents particular features and various complicating conditions requiring special treatment strategies.
Interferon, the standard treatment for HBV
infection, has been poorly tolerated by patients with
chronic kidney disease, has presented relatively low efficacy, and has posed renal transplant recipients under the risk of acute rejection. The advent of effective nucleos(t)ide analogs (
NAs) has offered the opportunity to minimize the consequences of HBV
infection in HBV-positive patients with
chronic kidney disease. Combination with
immunosuppressive agents might be considered in cases of rapid renal function deterioration and/or severe
proteinuria. Among the newer
NAs,
entecavir may be preferred, because of its high potency, high genetic barrier to resistance, and favorable renal safety profile. However,
entecavir presented low efficacy in case of
lamivudine or
telbivudine resistance, and thus
tenofovir may be a better option in that setting. All
HBsAg-positive candidates should be treated with
NAs before
renal transplantation in order to maintain undetectable HBV
DNA, reduce
liver fibrosis, and prevent hepatic decompensation after
renal transplantation. This review summarizes updated issues related to treatment of chronic HBV
infection in all categories of population with
chronic kidney disease (those exhibiting HBV-associated glomerular disease, those treated with
hemodialysis, as well as renal transplant candidates, donors, and recipients).