Hemodialysis and Viral Hepatitis

Hepatitis B Vaccination and Testing

Since the initiation of strict infection-control practices and Hepatitis B vaccination, the rate of Hepatitis B virus (HBV) infection among patients undergoing hemodialysis has declined approximately 95%. Nonetheless, repeated outbreaks of HBV infection among unvaccinated patients underscore the continued risk for infection in this population. In addition, primary HBV infections become chronic more frequently in immunosuppressed persons, including hemodialysis patients.

The Advisory Committee on Immunization Practices recommends universal vaccination of persons with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients. Other recommendations specific to this population are as follows:

Hepatitis B vaccination is recommended for pre-end-stage renal disease patients before they become dialysis dependent and for peritoneal and home dialysis patients because they might require in-center hemodialysis.
Higher Hepatitis B vaccine doses are recommended for adult dialysis patients and other immunocompromised persons. Compared with immunocompetent adults, hemodialysis patients are less likely to have protective levels of antibody after vaccination with standard vaccine dosages.
Serologic testing of hemodialysis patients and other immunocompromised persons is recommended 1–2 months after administration of the final dose of the primary vaccine series to determine the need for revaccination.
For hemodialysis patients, the need for Hepatitis B vaccine booster doses should be assessed by annual testing for antibody to Hepatitis B surface antigen (anti-HBs). A booster dose should be administered when anti-HBs levels decline to <10 mIU/mL.