Hepatitis B and C in peritoneal dialysis patients

In most countries the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in peritoneal dialysis (PD) patients is lower than in hemodialysis (HD) patients. Besides a history of blood transfusions, previous HD is an important risk factor for developing HCV infection in PD patients. Many HCV-positive patients already are anti-HCV-positive before initiation of PD. Seroconversion to HCV during PD treatment is, therefore, a rare event. HCV RNA in serum is positive in 53% to 84% of anti-HCV-positive patients. Routine screening for HBV and HCV by using a second- or third-generation enzyme-linked immunosorbent assay (ELISA) should be performed in PD patients every 6 months. Asymptomatic HBV and HCV infection may be detected by elevation of transaminases, but lower cut-off levels should be preferred in PD patients. Prophylactic strategies include hygienic measures and HBV vaccination. The staff should be aware of the infectiousity of the PD effluent, especially in hepatitis B surface antigen (HBsAg)-positive patients. Because of the smaller number of required blood transfusions and the increased use of home therapy, which reduces the risk for environmental contamination, PD is considered to be an important strategy for prevention of hepatitis in end-stage renal disease patients.