Prevalence of Hepatitis B core antibodies with negative Hepatitis B surface antigen in dialysis and chronic kidney disease patients.

Occult hepatitis B infection (OBI) is a potential cause of infection transmission in patients with chronic kidney disease (CKD) and dialysis-dependant patients. It is liable to be missed since the marker for OBI, hepatitis B core antibody (HBcAb), is not done routinely. We carried out a study to assess the prevalence of OBI in CKD Stage II-V or requiring renal replacement therapy. It was a cross-sectional study carried out at Fatima Memorial Hospital, Lahore, from May 2104 to May 2015. A total of 188 patients were included in this study, 124 were dialysis dependent and 64 had acute or CKD Stage II-V. About 17.55% (n = 33) of patients had isolated HBcAb positive. Nearly 33.5% (n = 63) of patients were found to have hepatitis B surface antigen positive, indicating development of immunity by exposure to virus. About 20.74% (n = 39) of patients were co-positive with HBcAb also. The prevalence of isolated HBcAb in dialysis and CKD patients is high; therefore, testing for HBcAb should be a routine part of screening in our CKD population to rule out OBI. Further confirmation with polymerase chain reaction analysis for HBV viral DNA is recommended. Considering our circumstances, a consensus statement from the hepatologists and nephrologists is needed to further plan for the management of such cases.