Background: Hepatitis B virus (HBV) immunization protocols are routinely followed in dialysis units. Recommendations for retesting and booster dose administration are variable and less well known.
Design: Quality improvement report.
Setting & participants: Provincial dialysis cohort in all 5 regional centers in British Columbia (n = 1,055).
Quality improvement plan: (1) Describe the variations in HBV testing practice patterns between centers and modalities of dialysis, (2) propose an evidence-based protocol for HBV follow-up testing, and (3) compare the current practice for HBV follow-up testing with the protocol.
Measures: (1) Number of HBV tests performed based on geographic center and dialysis modality; (2) tabulation of local, national, and international guidelines to determine concordance and develop British Columbian protocol, and (3) percentage of patients who received recommended HBV testing based on protocol.
Results: (1) Significant variation noted in HBV testing frequency among the 5 regional centers and between hemodialysis and peritoneal dialysis patients (P < 0.001); (2) current available guidelines generally are concordant, but vary in regard to frequency of follow-up testing; and (3) comparing recommended testing frequency with actual testing, 50% of patients were tested as recommended; 13%, less than recommended; and 37%, more than recommended. Hemodialysis patients often were tested more than recommended (hemodialysis, 47% versus peritoneal dialysis, 16%; P < 0.01). Patients with current or past HBV infection were tested more than recommended (P < 0.01). All variability remained significant when adjusted for age, sex, and dialysis therapy duration in a multivariate model.
Limitations: The cohort was ascertained from laboratory data; therefore, information for vaccination and booster dose administration was not available.
Conclusion: In a cohort of dialysis patients initially screened for hepatitis B, 50% of patients are being appropriately monitored with retesting compared with an evidence-based protocol. Patients with known HBV infection and hemodialysis patients are being tested more than recommended. Adherence to a protocol for retesting would ensure appropriate follow-up and reduce unnecessary retesting, potentially leading to significant cost savings.