Temporal Patterns of HBV Reactivation in Rituximab-Treated CKD Patients: An Exploratory Analysis of Baseline Quantitative HBsAg and Prophylaxis Duration.

Authors

Jing Fang, Yue Yang, Xu Wang, Wenge Li, Xinzhen Guo

Published in

Journal of nephrology. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Hepatitis B virus (HBV) reactivation is a severe complication in HBsAg-positive patients receiving rituximab (RTX) for chronic kidney disease (CKD). We evaluated clinical predictors of reactivation, optimal prophylaxis duration, and post-discontinuation risk kinetics.
We retrospectively analyzed 105 HBsAg-positive CKD patients treated with RTX. Participants were stratified by antiviral prophylaxis duration: Group A (≥ 12-18 months post-RTX, n=41), Group B (6-12 months, n=47), and Group C (< 6 months, n=17). Reactivation rates and risk factors were analyzed using univariate logistic regression, log-rank test and Kaplan-Meier survival curves.
The overall HBV reactivation was 7.6% (8/105). A significant "duration-dependent" protective effect was observed, with reactivation rates of 2.4%, 6.4%, and 23.5% in Groups A, B, and C, respectively (P = 0.012). Baseline HBsAg > 2.4 log10 IU/mL (OR = 12.5, P = 0.005) and antiviral prophylaxis duration < 6 months (OR = 6.8, P = 0.023) emerged as noteworthy clinical factors closely linked to reactivation risk. Furthermore, Kaplan-Meier curves confirmed a distinct temporal clustering of reactivation between 4 and 10 months following prophylaxis cessation.
An extended 12-18 months antiviral prophylaxis regimen provides optimal protection against HBV reactivation in CKD patients. Baseline HBsAg > 2.4 log10 IU/mL represents a noteworthy marker of heightened risk. Due to the limitations of a small event size, these findings remain exploratory and hypothesis-generating. Crucially, the observed temporal clustering between 4 and 10 months indicates a distinct post-prophylaxis risk timeline compared to non-renal populations, highlighting the need for further tailored, prospective validation.

PMID:
42581782
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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