SHM Converge Scientific Abstract ePoster Gallery-Hepatitis B Unmasked: A Lurking Wolf in Patients With Chronic Kidney Disease

Pdf Summary

This case describes a 72-year-old man with end-stage renal disease on hemodialysis who developed severe acute hepatitis from hepatitis B reactivation despite a history of previously negative HBsAg and HBV DNA three months earlier. He presented with abdominal pain, jaundice, right upper quadrant tenderness, marked transaminitis, hyperbilirubinemia, and extreme hyperferritinemia. Further testing revealed positive HBsAg and HBeAg with a very high HBV viral load, confirming active HBV infection.<br /><br />He was treated with entecavir once weekly, which initially improved liver tests, but his condition worsened with encephalopathy, hypoglycemia, and bradycardia. He was not considered a liver transplant candidate because of active infection, and after discussion with family, care was transitioned to comfort measures.<br /><br />The case highlights that HBV reactivation can occur in dialysis patients even without obvious immunosuppression and may be associated with severe morbidity and mortality. The authors emphasize the importance of prevention and surveillance in patients with chronic kidney disease and prior HBV exposure. Dialysis patients should receive HBV vaccination, have annual anti-HBs titers checked, and maintain protective antibody levels of at least 10 mIU/mL. Booster doses or repeat vaccination series may be needed, and non-responders require close monitoring.<br /><br />For patients with active HBV disease, elevated HBV DNA, and HBsAg positivity, antiviral therapy is recommended, with entecavir often preferred. Regular monitoring of liver function tests and HBV markers is essential in dialysis patients with prior HBV infection or positive core antibody to reduce the risk of reactivation and complications.

Asset Subtitle

Vijairam Selvaraj

Meta Tag

Author List Kwame Dapaah-Afriyie, Vijairam Selvaraj

Category Clinical Vignettes

Concept Hepatitis B Reactivation

Concept Chronic Kidney Disease

Concept Hemodialysis

Concept Aminotransferase Elevation

Concept HBV DNA

Distinguished Non-Finalist

Presenter Organization Miriam Hospital

Presenting Author Vijairam Selvaraj

Track Adult

Keywords

hepatitis B reactivation

hemodialysis

end-stage renal disease

acute hepatitis

HBsAg positivity

HBV DNA

entecavir

hyperferritinemia

liver failure

HBV vaccination

Hepatitis B Reactivation

Chronic Kidney Disease

Hemodialysis

Aminotransferase Elevation

HBV DNA