Hepatitis B in a pediatric hemodialysis unit

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Hepatology

Background:

• Hepatitis B virus (HBV) infection is a significant concern in patients undergoing hemodialysis.
• Pediatric hemodialysis patients are particularly vulnerable to HBV transmission.
• Understanding the incidence and transmission routes of Hepatitis B antigen (HB Ag) is critical in this population.

Purpose of the Study:

• To determine the incidence of HB Ag positivity in children undergoing hemodialysis.
• To investigate the potential sources of HB Ag transmission, including equipment contamination.
• To assess the clinical and biochemical manifestations of hepatic dysfunction in infected children.

Main Methods:

• Serial HB Ag determinations were performed on 62 pediatric hemodialysis patients over 3.5 years.
• HB Ag positivity was defined as a titer greater than 1:8.
• Biochemical evidence of hepatic dysfunction and clinical manifestations were monitored.

Main Results:

• 58% of patients had at least one positive HB Ag determination.
• 89% of those who became HB Ag positive during dialysis acquired it within the initial 6 months.
• 67% of HB Ag positive patients showed biochemical hepatic dysfunction, with younger children (<12 years) having less hepatic involvement.

Conclusions:

• The high incidence and temporal association with dialysis duration suggest equipment contamination as a transmission source.
• HB Ag can persist intermittently for over 3 years.
• Preventing HB Ag acquisition in pediatric hemodialysis patients is essential.