Variability of Hepatitis B Testing in British Columbian ESRD Patients: The Case to Focus on Implementation of Guidelines

Abstract

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. Quality improvement report. Provincial dialysis cohort in all 5 regional centers in British Columbia (n = 1,055). (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. (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. (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. The cohort was ascertained from laboratory data; therefore, information for vaccination and booster dose administration was not available. 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.