Hepatitis B, Hepatitis C, and HIV Seroprevalence and Their Association with Dialysis Adequacy and Glycaemic Parameters in Haemodialysis Patients: A Cross-Sectional Study from Somalia.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections disproportionately affect haemodialysis (HD) patients in sub-Saharan Africa, yet Somali data remain scarce. We aimed to determine HBsAg, anti-HCV, and anti-HIV seroprevalence among HD patients in Mogadishu and to identify independent predictors of HBsAg seropositivity among measures of dialysis adequacy and glycaemic parameters. METHODS: Single-centre retrospective cross-sectional study of 599 HD patients in Mogadishu, Somalia (June 2024-February 2026). Urea reduction ratio (URR) was calculated from pre- and post-dialysis urea. Bivariable comparisons used Mann-Whitney U, Fisher exact, and chi-square tests. Multivariable logistic regression assessed independent predictors of HBsAg positivity, adjusting for age, sex, fasting glucose, URR, and pre-dialysis creatinine (n=569 complete cases). RESULTS: HBsAg positivity was 5.5% (33/599) and anti-HCV 2.3% (14/599); no patient was HIV-positive. HBsAg-positive patients were older, more frequently male, and had higher pre-dialysis urea, creatinine, URR, and fasting glucose (all p<0.05), with equivalent post-dialysis clearance; HbA1c, AST, and ALT did not differ. Anti-HBs titres were near-absent in HBsAg-positive patients (0.3 vs 26.3 IU/L; p<0.001). On multivariable analysis, older age (OR 1.023), male sex (OR 2.457), and higher URR (OR 1.031) independently predicted HBsAg positivity (AUROC 0.753); fasting glucose and creatinine were not independent after adjustment. With an events-per-variable ratio of 6.2, these findings are hypothesis-generating. CONCLUSION: Age, male sex, and URR not glycaemic or hepatic parameters independently predicted HBsAg positivity in this cohort. Near-absent anti-HBs titres indicate a critical vaccination gap, supporting universal hepatitis B screening, high-dose vaccination before dialysis initiation, and enhanced infection control in resource-limited settings.