Hepatitis B in Hemodialysis: Serologic Dynamics and Implications for Care

Background: Hemodialysis patients are particularly vulnerable to hepatitis B virus (HBV) due to immunosuppression and repeated vascular access. While universal childhood vaccination has reduced population-level HBV prevalence, dialysis units require tailored prevention and monitoring strategies. This study aimed to characterize HBV serologic profiles, evaluate immune responses, and assess the kinetics of antibody waning in a diverse hemodialysis population. Methods: We retrospectively analyzed 565 adult hemodialysis patients (2015-2024), assessing HBV seroprevalence, seroconversion, booster response, and antibody waning. Subgroup comparisons were made by ethnicity and birth cohort (pre- vs. post-1992 national vaccine rollout). Time-to-waning analyses were performed using Kaplan-Meier methods. Results: HBsAg and anti-HBc were positive in 4.1% and 31.7% of patients, respectively; 3.7% were HCV seropositive. No HBsAg seroconversions occurred, and 2.1% of initially anti-HBc-negative patients seroconverted. Among patients with isolated anti-HBc, 80.9% developed protective anti-HBs titers, and none became HBsAg- or HBV DNA-positive. Waning anti-HBs titers occurred in 67.5% (median: 7.3 months), with 87.4% demonstrating a serologic response following documented vaccine delivery. Patients born after 1992 showed higher isolated anti-HBs positivity and lower anti-HBc prevalence. Ethnic subgroup analysis showed higher exposure rates but similar booster response among minority patients. Conclusions: HBV serologic profiles in this hemodialysis cohort reflected the interplay of immunosuppression, vaccination practices, and evolving epidemiologic trends. Subgroups exhibited variable vaccine responses, differing patterns of antibody waning, and a low incidence of new infections. These findings support tailored, population-specific HBV monitoring and prevention strategies in dialysis care.