The hepatitis virus infection and renal replacement therapies: What is the relation?

Dear Editor, We read the article “Prevalence of hepatitis B and C virus infections and immunity among hemodialysis patients in the Mazandaran province, Northern Iran”[1] published in the Journal of Family Medicine and Primary Care, Volume 11, Issue 5 with interest. The authors investigated the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in hemodialysis patients. Many patients had a non-protective serum level of HBsAg. Authors have also reported that there has been a decreasing trend of HBV and HCV infections over the past years in the region. HBV and HCV infections are highly contagious and transmit from person to person by percutaneous (blood transfusion), sexual, and vertical routes. These are the most frequent infections among renal disease patients.[2] Within the hemodialysis unit, these infections are typically spread from patient to patient. Because End-stage renal disease (ESRD) is associated with immune suppression, individuals receiving hemodialysis who have ESRD are at an increased risk of getting HBV and HCV infections.[3] HBV and HCV infections can be an added insult to injury in ESRD patients by causing liver disorders such as cirrhosis and hepatocellular carcinoma. The prevalence of HBV among hemodialysis patients ranges between 1.2% and 6.6% in developed countries and 1.3% to 14.6% in developing countries.[4] At the same time, the prevalence of HCV seropositivity in hemodialysis patients ranges from 1.4% to 28.3% in developed countries and 4.7% to 41.9% in developing countries.[5] There has been a decreasing trend of HBV and HCV infections worldwide in ESRD patients undergoing hemodialysis. HCV and HBV infections are often considered systemic disorders associated with intrahepatic and extrahepatic manifestations such as glomerulonephritis and vasculitis of various types. The prevalence of hepatitis-associated nephropathy shows similar trends as the prevalence and distribution of HBV and HCV infections. This suggests another link and causal–reverse–causal association between kidney disease and hepatitis viremia. Though the findings from the studies suggest that there is a decreasing trend of HBV and HCV infections in hemodialysis patients in Iran; more efforts are needed for low-middle-income countries to decrease these trends. To reduce the incidence of HBV infection in patients on hemodialysis, Centers for Disease Control and Prevention (CDC) has recommended a 40 mg dose of vaccine by intramuscular (IM) route at 0, 1, 2, and 6 months.[6] In conclusion, the decrease in trend in infection rates of HBV and HCV in hemodialysis patients is attributed to better infection control practices, strict adherence to universal hygiene practices, improved patient care, routine screening of hemodialysis patients for HBV and HCV, and use of hepatitis B vaccine to prevent HBV infection. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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