Efficacy of HBV Vaccination in Various Stages of Chronic Kidney Disease: Is Earlier Better?

Abstract

BackgroundDespite improvement in hepatitis B infection prevention through national vaccination programs, implementation of compulsory and thorough blood donor screening, and reduction of transfusion numbers due to erythropoietin administration,hepatitis B remains a major concern in hemodialysis (HD) centers [1]. Compared to aresponse rate of over 90% in the normal population, only 50 to 60% of those with endstage renal disease (ESRD) achieve protective antibody levels following immunization against hepatitis B [2][3]. Various strategies have been developed to overcome the low seroconversion rate in ESRD patients, including co-administering zinc, gamma-interferon,thymopentin, interleukin-2, and levamisole as immunostimulants or adjuvants [3][4],changing the injection mode (intradermal versus intramuscular), or doubling the vaccine dose [5].ObjectivesPrevious studies demonstrated that renal failure patients benefit from HBV vaccination; however, not all studies have demonstrated this. Therefore, we compared the rates of seroconversion (hepatitis B surface antibody [HBsAb] titer > 10 IU/mL) in patients at various stages of chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) who received HBV vaccination.Patients and MethodsA total of 167 patients in 3 different stages of CKD were vaccinated against HBV. Each patient received the vaccine according to a standardized vaccination schedule consisting of 40 μg of the recombinant vaccine “Engerix” at 0, 1, and 6 months.Eight to 12 weeks after the last dose of vaccination, anti-HBsAb levels were measured.ResultsMean age and eGFR were 57.4 ± 16.5 years and 26.7 ± 14.7 mL/min/1.73 m2, respectively.The overall seroconversion rate was 78%. Although a significant correlation between HBsAb titer and eGFR (r = 0.265, P = 0.001) was observed, in the multivariate analysis using age, CKD stage, diabetes mellitus, and gender as independent variables,the degree of renal function did not significantly contribute to seroconversion. In contrast,higher age (> 60 years) showed a significant negative correlation to seroconversion (odds ratio = 0.22; P = 0.004).ConclousionsCKD patients of advanced age should be vaccinated against HBV. Although higher eGFR was not associated with improved seroconversion, the persistence of seroconversion was not evaluated; future studies should be conducted to develop recommendations for earlier or later vaccination.

A Randomized Controlled Trial of Two Schedules of Hepatitis B Vaccination in Predialysed Chronic Renal Failure Patients

“…This was similar to DaRoza et al’s study [30]. The seroconversion rate in the Hashemi et al study was 78%, (lower than the results of our study) [28]. Edey et al [31] in a review article explained that the 3-dose schedule of HBV vaccine in immunocompetent individuals may lead to a 90–95% seroprotection rate; however, in patients with renal failure, the rates were lower.…”

Hepatitis B Vaccination in Chronic Kidney Disease: Review of Evidence in Non-Dialyzed Patients

“…In the study by Hashemi et al (14) a higher estimated GFR was not associated with significantly improved seroconversion, but their data (not adjusted for significant differences in age, body mass, and hemoglobin between groups) also indicate statistically borderline decrease (P = 0.067) in positive response with deteriorating GFR: 80% in CKD stage 3, 76% in CKD stage 4 and 67% in CKD stage 5. Moreover, data by Hashemi et al (14) showed a significant positive correlation between an anti-HBs titer and estimated GFR.…”

“…Moreover, data by Hashemi et al (14) showed a significant positive correlation between an anti-HBs titer and estimated GFR. CKD stage, however, was not associated with seroconversion in the multivariate analysis.…”

Immune Response of Hepatitis B Vaccine Among Persons With Diabetes

“…Subjects in the studies among adults and children generally lacked comorbidities (including kidney disease) other than diabetes. One study among hemodialysis/chronic kidney disease patients included only subjects with chronic kidney disease (i.e., no hemodialysis patients) (32), and three studies included both hemodialysis and chronic kidney disease patients (36,42,44), one of which also included peritoneal dialysis patients (44). The remainder were comprised entirely of hemodialysis patients.…”