Hepatitis B and chronic kidney disease: Bench to bedside.

Chronic kidney disease (CKD) has an intricate relationship with hepatitis B virus (HBV) due to impaired immune status and repeated risk for HBV exposure in people with CKD. Extensive discussion is required on issues related to disease burden, progression of acute HBV infection to chronic infection, impaired immune response to the hepatitis B vaccine, optimal vaccination schedules and strategies, etc. In this review, we attempted to summarize the updated existing knowledge on these topics. In addition, the implication of HBV in the pathogenesis of glomerular disease is also discussed. This review extensively focused on issues related to hepatitis B vaccine induced immune response in CKD patients-serological and cell-mediated immune responses to the vaccine, with particular emphasis on effect of CKD stages on vaccine response, newer types of hepatitis B vaccines for non-responders, revaccination strategies, and the durability of vaccine-induced immunity. We also discussed the literature on risk of HBV transmission following organ from hepatitis B surface antigen (HBsAg)-positive donors, along with perioperative management when the donor is HBsAg-positive but the recipient is HBsAg-negative.