Hepatitis B Vaccination in Dialysis Patients and Nutritional Status

Lombardi, Marco; Pizzarelli, Francesco; Righi, Maria; Cerrai, T; Dattolo, Piero; Nigrelli, Santi; Michelassi, Stefano; Sisca, Sergio; Alecci, A; Geronimo, P. Di; Maggiore, Q

doi:10.1159/000186900

Cited by 26 publications

(28 citation statements)

References 6 publications

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“…A list of the 94 bibliographic references is available from the authors on request. Eleven papers [12,13,14,15,16,17,18,19,20,21,22], representing a total of 862 unique patients, were included in our meta-analysis. There was a 100% concordance between reviewers with respect to final inclusion and exclusion of studies reviewed based on the predefined inclusion and exclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

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Erythropoietin Use and Immunogenicity of Hepatitis B Virus Vaccine in Chronic Kidney Disease Patients: A Meta-Analysis

Fabrizi

Dixit

Martin

2012

Kidney Blood Press Res

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Background: It is known that the immunogenicity of hepatitis B virus (HBV) vaccine is lower in uremic patients than healthy subjects. Numerous inherited or acquired factors have been implicated in this lowered response, and the high frequency of recombinant human erythropoietin use among patients on maintenance dialysis has been suggested to play a pivotal role. However, the impact of therapy with recombinant erythropoietin on the immune response to HBV vaccine in patients with chronic kidney disease (CKD) is not appropriately detailed. Aim: To evaluate the influence of human recombinant erythropoietin therapy on the immunological response to HBV vaccine in CKD patients by performing a systematic review of the literature with a meta-analysis of clinical studies. Methods: We used the random-effects model of DerSimonian and Laird with heterogeneity and sensitivity analyses. The end-point of interest was the rate of patients showing seroprotective anti-hepatitis B titers at completion of a hepatitis B vaccine schedule among human erythropoietin users versus those who did not receive the drug in a CKD population. Results: We identified 11 studies involving 862 unique patients with CKD. Aggregation of study results did not show a significant increase in response rates among erythropoietin user versus non-user patients (pooled odds ratio = 1.431; 95% CI 0.954; 2.146), according to a random-effects model. No heterogeneity was found, the p value was 0.1 for our test of study heterogeneity (Q = 14.147). Stratified analysis in various subgroups of interest did not significantly change these findings. Conclusions: Our meta-analysis showed no link between immunological response to HBV vaccine and therapy with human recombinant erythropoietin among individuals on long-term dialysis. We suggest the use of recombinant vaccine towards hepatitis B in patients on regular dialysis irrespective of erythropoietin treatment.

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Section: Resultsmentioning

confidence: 99%

“…There was 1 randomized clinical trial [17 ]and 10 cohort studies, 2 prospective [16,19] and 2 retrospective [20,21]. The design of the study (prospective or retrospective) remained unclear in 5 studies [12,13,15,18,22]. Khan et al [14] collected prospectively data on HD and retrospectively on peritoneal dialysis (PD) patients.…”

Section: Resultsmentioning

confidence: 99%

Erythropoietin Use and Immunogenicity of Hepatitis B Virus Vaccine in Chronic Kidney Disease Patients: A Meta-Analysis

Fabrizi

Dixit

Martin

2012

Kidney Blood Press Res

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“…Concomitant infection with HCV has a negative influence on vaccination with recombinant HBsAg as well [8,19]. Malnutrition (determined by concentrations of albumin, pre-albumin, and pre-dialysis blood urea nitrogen) had a negative influence on vaccination with recombinant HBsAg [17,20].…”

Section: Discussionmentioning

confidence: 99%

Efficient Haemodialysis Improves the Response to Hepatitis B Virus Vaccination

Kovačić¹,

Šain²,

Vukman³

2002

Intervirology

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Background: As patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus surface antigen (HBsAg), we conducted this study to see how dialysis efficacy affects response to hepatitis B virus (HBV) vaccination. Methods: Study subjects consisted of 30 PCHD. All subjects were vaccinated with 4 × 40 µg HBsAg i.m. at 0, 1, 2, and 6 months. If a subject had an HBsAg antibody (HBsAb) level <10 IU/l after vaccination, he or she received a booster dose. Subjects were divided into groups according to the level of HBsAb: non-responders (<10 IU/l), weak responders (10–100 IU/l), and good responders (>100 IU/l). Results: The group of responders had a significantly more efficient dialysis (Kt/V) than the group of non-responders (p = 0.027). This difference was not observed between groups of non-responders and weak responders. The group of good responders had a significantly better Kt/V than the group of non-responders (p = 0.012). Good responders had a significantly better Kt/V than weak responders (p = 0.019). Kt/V values showed a significantly positive correlation with the HBsAb level (r = 0.47; p = 0.006). Conclusions: The HBV vaccination reaction was weaker in PCHD with inefficient dialysis. Efficient haemodialysis significantly improves the response to vaccination with recombinant HBsAg.

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“…In addition to the immune compromise conferred by uremia, a series of host factors may affect the responsiveness to HBV vaccine in the HD population: Nutritional status [94,95], diabetes mellitus [96], male sex [97], body weight [98], older age [99], blood transfusion history [100], serological positivity for HCV markers [101], HLA genetic heterogeneity [102][103][104] and impaired antigen receptor expression [105]. Paradoxically, some reports [99,106] observed that responder vaccinees have been on HD longer than nonresponders; patients who survive on HD for longer periods are generally healthier and may be better able to develop an antibody response.…”

Section: Hbv Vaccination In Dialysis: Short-term Studiesmentioning

confidence: 99%