Hepatitis B and C among chronic dialysis adults in central South Africa: A retrospective review

Background: Patients with chronic kidney disease (CKD), especially those on dialysis, have an increased risk of viral hepatitis B (HBV) and C (HCV) infection. The South African Renal Society recommends regular screening to ensure early detection, appropriate treatment and vaccination update for hepatitis B. Chronic kidney disease patients tend to have a poor immune response post-vaccination. Objectives: The study investigated the prevalence of HBV and HCV, screening practices and immune response to HBV vaccination among patients on state-funded dialysis in the Free State province. Method: Records of patients on chronic dialysis in 2021 were included in the study. Data were extracted from paper-archived and electronic medical and laboratory records. Results: In total, 223 records were included. Over 90% of patients were screened for hepatitis B and C at baseline at all dialysis units, which decreased to 30% at some satellite units at follow-up screening. The seroprevalence for both HBV and HCV was 1.8%. Viral hepatitis B immunity was found in 78.4% of patients. Patients with a mean age of 45 years were more likely to have increased antibody titres. Human immunodeficiency virus seropositive patients were more likely to have lower antibody titres when repeated at 6 months. The vaccination rate was 74.5%. The vaccination non-response rate was 9.8% with no variable demonstrating a significant effect on vaccine response. Conclusion: Both HVB and HCV prevalence were lower than described in similar settings with equal distribution between dialysis modalities. Screening was adequate at baseline but decreased at follow-up, resulting in non-identification of patients possibly needing re-vaccination. Contribution: Missed opportunities are concerning and call for action to strengthen the outreach service to satellite dialysis units located in regional hospitals.