Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better

DaRoza, Gerald; Loewen, Andrea; Djurdjev, Ognjenka; Love, Janet; Kempston, Cathy; Burnett, Shelley; Kiaii, Mercedeh; Taylor, Paul A.; Levin, Adeera

doi:10.1053/j.ajkd.2003.08.019

Cited by 200 publications

(170 citation statements)

References 43 publications

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“…In general, patients with kidney dysfunction have been observed to have lower rates of vaccine response and a more rapid decline of antibody levels after vaccination (30). Although lower vaccine responsiveness has been widely recognized in the ESRD population, to what extent moderate to advanced CKD modifies vaccine responsiveness remains unclear (31,32).…”

Section: Risk Factors For Infection In Ckd and Esrdmentioning

confidence: 99%

“…In patients with ESRD, studies using Engerix B have shown variable response rates ranging from approximately 60 to 80% depending on the dosage, number of vaccinations, route of administration (intradermal versus intramuscular), and study population (46 -49). Among patients with moderate to advanced CKD, vaccine responsiveness has also been shown to range from approximately 60 to 80% depending on the dosage, number of administered vaccines, and study population (31,32). Findings have been inconsistent as to whether level of estimated GFR affects vaccine responsiveness in patients with CKD (31,32).…”

Section: Vaccinationmentioning

confidence: 99%

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Epidemiology of Acute Infections among Patients with Chronic Kidney Disease

Dalrymple¹,

Go²

2008

Clinical Journal of the American Society of Nephrology

201

183

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The objectives of this review were (1) to review recent literature on the rates, risk factors, and outcomes of infections in patients who had chronic kidney disease (CKD) and did or did not require renal replacement therapy; (2) to review literature on the efficacy and use of selected vaccines for patients with CKD; and (3) to outline a research framework for examining key issues regarding infections in patients with CKD. Infection-related hospitalizations contribute substantially to excess morbidity and mortality in patients with ESRD, and infection is the second leading cause of death in this population. Patients who have CKD and do not require renal replacement therapy seem to be at higher risk for infection compared with patients without CKD; however, data about patients who have CKD and do not require dialysis therapy are very limited. Numerous factors potentially predispose patients with CKD to infection: advanced age, presence of coexisting illnesses, vaccine hyporesponsiveness, immunosuppressive therapy, uremia, dialysis access, and the dialysis procedure. Targeted vaccination seems to have variable efficacy in the setting of CKD and is generally underused in this population. In conclusion, infection is a primary issue when caring for patients who receive maintenance dialysis. Very limited data exist about the rates, risk factors, and outcomes of infection in patients who have CKD and do not require dialysis. Future research is needed to delineate accurately the epidemiology of infections in these populations and to develop effective preventive strategies across the spectrum of CKD severity.

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Section: Risk Factors For Infection In Ckd and Esrdmentioning

confidence: 99%

Section: Vaccinationmentioning

confidence: 99%

Epidemiology of Acute Infections among Patients with Chronic Kidney Disease

Dalrymple¹,

Go²

2008

Clinical Journal of the American Society of Nephrology

201

183

View full text Add to dashboard Cite

show abstract

“…Nosocomial transmission is common (e.g., respiratory syncytial virus [RSV], influenza) and can be reduced by careful hand sanitation and vaccination of staff. Pre-exposure vaccination (for example, HBV or varicella vaccine) should occur at the earliest signs of chronic renal failure, before the response to vaccines wane; for example, patients with higher GFR levels are more likely to respond to hepatitis B vaccination (62). Patients at risk for sexual transmission of viral infections should be counseled about sexual practices.…”

Section: Epidemiology: Infections From Donor and Communitymentioning

confidence: 99%

Viral Infection in the Renal Transplant Recipient

Kotton

Fishman²

2005

Journal of the American Society of Nephrology

200

181

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Viruses are among the most common causes of opportunistic infection after transplantation and the most important. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Viral infection, both symptomatic and asymptomatic, causes the "direct effects" of invasive disease and "indirect effects," including immune suppression predisposing to other opportunistic infections and oncogenesis. Rapid and sensitive microbiologic assays for many of the common viruses after transplantation have replaced, for the most part, serologic testing and in vitro cultures for the diagnosis of infection. Furthermore, quantitative molecular tests allow the individualization of antiviral therapies for prevention and treatment of infection. This advance is most prominent in the management of cytomegalovirus, Epstein-Barr, hepatitis B, and hepatitis C viruses. Diagnostic advances have not been accompanied by the development of specific and nontoxic anti-viral agents or effective antiviral vaccines. Vaccines, where available, should be given to patients as early as possible and well in advance of transplantation to optimize the immune response. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections.

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“…Insbesondere die funktionelle Beeinträchtigung der dendritischen Zellen wird heute als eine der Hauptursachen sowohl für die erhöhte Infektanfälligkeit als auch für die verminderte Impfantwort angesehen [33]. Die Beeinträchtigung der Immunantwort ist klar stadienabhängig (G1 bis G5; entsprechend der Klassifizierung der Guidelines der "Kidney Disease Improving Global Outcomes Work Group 2012", wobei Patienten mit den Stadien G3b [ ), G4 (GFR 15-29) und G5 (GFR < 15; Nierenversagen; "end stage renal disease" -ESRD) die deutlichste und klinisch relevanteste Immunsuppression bei Impfantworten aufweisen, während Patienten mit den Stadien G1 bis G3a zumindest im Hinblick auf die Hepatitis-B-Immunantwort vergleichbar wie gesunde Kontrollen antworten [34].…”

Section: Chronische Nierenerkrankungen/dialysepatientenunclassified