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[Hepatopathy and hepatitis B virus infection in dialysis patients: cross-sectional study]
Insights
Hepatitis B surface antigen (HBsAg) positive patients undergoing dialysis show higher liver enzyme levels, indicating increased hepatocellular damage. Active viral replication in these patients correlates with the most significant liver injury.
Area of Science:
- Nephrology
- Hepatology
- Virology
Context:
- Hepatitis B virus (HBV) infection control in dialysis units is crucial for managing end-stage renal disease (ESRD).
- Patients with chronic HBV infection are a continuous pool for dialysis and transplant candidates.
- The clinical impact of Hepatitis B surface antigen (HBsAg) in dialysis patients remains incompletely understood.
Purpose:
- To assess the influence of virological and host factors on hepatocellular damage in dialysis patients.
- To analyze demographic, biochemical, and virological data from a large cohort of maintenance dialysis patients (n=464).
- To determine the relationship between Hepatitis B virus (HBV) markers and serum aminotransferase activity.
Summary:
- HBsAg positivity was found in 8.2% of the dialysis population.
- HBsAg positive patients exhibited significantly higher serum aminotransferase (AST and ALT) levels compared to HBsAg negative individuals.
- Active viral replication (HBeAg positive) in HBsAg positive dialysis patients was associated with the highest liver enzyme levels.
- Multivariate analysis confirmed an independent association between HBsAg presence and elevated AST/ALT levels, and between age and ALT.
Impact:
- HBsAg positive dialysis patients demonstrate elevated liver enzyme activity, suggesting hepatocellular damage.
- Patients with active HBV replication show the most pronounced liver injury.
- Findings highlight the importance of monitoring liver health in dialysis patients with HBV infection.
Background:
Control of spread of HBV infection in dialysis units in developed countries has been one of the major advances in managing end-stage renal disease (ESRD). Patients with chronic HBV, however, continue to enter the population pool of dialysis patients and transplant candidates. The clinical significance related to the presence of HBsAg in serum of dialysis patients has not been completely understood.
Aim And Methods:
We collected demographic, biochemical and virological data from a large (n=464) population of patients on maintenance dialysis. This was done to assess the influence of virological and host factors on hepatocellular damage, as shown by serum aminotransferase activity.
Results:
The frequency of HBsAg positivity in our dialysis population was 8.2 % (38/464); the rate of HBsAg positive patients showing HBe antigen was 20.6% (7/34). Twenty-two (84.6%) of 26 HBsAg positive patients showed detectable HBV DNA in serum by Amplicor HBV MonitorTM Test. HBsAg positive patients had serum aminotransferase activity significantly higher than HBsAg negative individuals; GOT (AST) 25.1+/-29.9 vs. 16+/-21.5 UI/L (p=0.001), and GPT (ALT) 31.3+/-52.5 vs. 17.7+/-21.9 UIL (p=0.034). In the subset of HBsAg positive dialysis patients, those in the replicative phase HBeAg positive) had aminotransferase activity higher than HBeAg negative individuals, AST, 42.3+/-43.6 vs. 22.4+/-27.3 UI/L (p=0.097) and ALT, 49.41+/-54.7 vs. 29.17+/-55.76 UI/L (NS) respectively. We did a multivariate analysis by standard least square model on the entire patient group and we found independent and significant association between detectable HBsAg in serum and AST (p=0.0089)and ALT (p=0.0159) values. There was an independent and significant relationship between age and ALT (p=0.01).
Conclusions:
In our study group, HBsAg positive patients on dialysis had serum aminotransferase activity significantly higher than that measured in HBsAg negative individuals. However, mean transaminase levels in HBsAg positive patients on dialysis were below the upper limit of normal for the reference range of healthy controls. HBsAg positive dialysis patients with active viral replication showed the greatest liver damage. Studies are in progress to understand further HBV-related liver disease in dialysis population.