Management of hepatitis B and C in special population

Table 1 Hepatitis B in chronic kidney disease

	HBV and CKD
Prevalence of CKD in HBV patients	8%
Pathogenesis	Direct cytopathic effect of the HBV on cells of the kidney; Glomerular deposition of immune complexes; Virus-induced specific immunological effector mechanisms (specific T lymphocyte or antibody); CHB induced cytokine toxicity on renal tissue
Risk factors	Smoking, diabetes mellitus, hypertension, cirrhosis.
Common type of renal injury	Membranous GN; Membranoproliferative GN; Polyarteritis nodosa; IgA nephropathy
Treatment indication	HBV DNA 2000 IU/mL with or without elevated ALT; Liver biopsy-chronic hepatitis with > F1 fibrosis; If planned for renal transplant, initiate NUCs 2 wk before transplant even if DNA ≤ 2000 IU/mL
Safe drugs	TAF (no dose adjustment till eGFR < 15 mL); ETV and TDF (If GFR > 50: ETV 0.5 mg/d or TDF 300 mg/d; GFR 30-49: ETV 0.5 mg alternate day or TDF 300 mg alternate day; GFR 10-29: ETV 0.5 mg once in 3 d and TDF 300 mg once in 3 d; on HD-ETV 0.5 mg or TDF 300 mg after every dialysis or every 7 d)
Prevention	Regular screening; Vaccination (double dose); Serology should be performed every year, and a booster dose should be given if antibody titers are below 10 mIU/mL.

HBV: Hepatitis B virus; CKD: Chronic kidney disease; CHB: Chronic hepatitis B; NUC: Nucleos(t)ide analogues; TDF: Tenofovir disoproxil fumarate; TAF: Tenofovir alafenamide fumarate; ETV: Entecavir; GFR: Glomerular filtration rate; GN: Glomerulonephritis; ALT: Alanine transaminase.