title: Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: the DOPPS.
abstract: BACKGROUND
  Hepatitis B (HBV) historically has been a public health issue within hemodialysis units. This study estimates HBV prevalence and seroconversion rates across seven countries and investigates associations with facility level practice patterns.
  
  
  METHODS
  The study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a cross-sectional, prospective, observational study of adult hemodialysis patients randomly selected from 308 dialysis facilities in France, Germany, Italy, Spain, the United Kingdom, Japan, and the United States. Logistic regression was used to model the odds ratio (OR) of HBV prevalence, and Cox regression was used to model time from entry into the study to HBV seroconversion.
  
  
  RESULTS
  In this sample, mean HBV facility prevalence was 3.0% with a median of 1.9%. The percentage of facilities with an HBV prevalence 0% to 5% was 78.5%. Adjusted HBV prevalence was higher in France, Germany, and Italy and lower in Japan and the United Kingdom. The majority of facilities (78.1%) had a seroconversion rate of 0 conversions per 100 patient-years. Presence of a protocol for HBV-infected patients was significantly associated with HBV seroconversion in the separate practice pattern model [risk ratio (RR) = 0.52, P = 0.03] and in the combined practice pattern model (RR = 0.44, P = 0.01).
  
  
  CONCLUSIONS
  There are differences in HBV prevalence and rate of seroconversion both at the country and the hemodialysis facility level. Presence of a protocol for HBV-infected patients was strongly and significantly associated with decreased risk for seroconversion. The observed variation suggests opportunities for improved HBV outcomes with further definition of optimal practice patterns at the facility level.
authors.affiliation: Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA. rburdick@umich.edu
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Burdick
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bragg-Gresham
authors.forename: John D
authors.initials: JD
authors.lastname: Woods
authors.forename: Sara A
authors.initials: SA
authors.lastname: Hedderwick
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: John
authors.initials: J
authors.lastname: LaBrecque
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011897:Random Allocation; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology