Thalidomide-induced heart block in a dialysis patient

Today, the increased life expectancy of chronic dialysis patients allows HBV to manifest all biological effects it can produce: asymptomatic antigenaemia, cirrhosis, hepatocellular carcinoma and viral reactivation post-renal transplant immunosuppressive therapies. Recently, some studies reported occult HBV infection in haemodialysis patients [4,5]. We would like to communicate our experience about HBV presence among dialysis patients. From January to May 2005, we screened 101 chronic dialysis patients who were consecutively admitted to the Civic Hospital Palermo, Italy. We did not include individuals with a history of alcohol abuse, illicit drug use, HIV infections or malignancy. Among the subjects examined, 1 was of Black African origin and 1 of Asian ethnicity; 99 were from Sicily; none had previous renal transplant or immunosuppressive therapy; 58 were males and 43 females with a mean age of 51 years. The major causes of IRC were diabetes mellitus and hypertension; 75 patients underwent haemodialysis and 26 peritoneal dialysis. The mean time on dialysis was 28 months. We identified four HBsAg-positive and DNA-HBV-positive patients (from 6– 170 000 UI/ml). We found 97 HBsAg-negative patients: among these subjects, 22 were vaccinated for HBV infection, 29 were non-vaccinated and 46 had natural HBV infection; 79 were HCV negative and 18 HCV positive; in these patients, hepatic function tests always showed normal values. There were no echographic signs of liver disease. Among the HBV-negative patients, the DNA-HBV detection was always negative. In our experience, no occult HBV infection was found in the 97 HBsAg-negative patients. Nowadays, we would not recommend DNA-HBV screening as a routine virological control in dialysis services. Instead, we suggest DNA-HBV screening for patients on the kidney transplant waiting list and in patients with abnormal liver function tests.