The Relationship Between Erythropoietin Resistance and Antibody Response to Hepatitis B Vaccine in Hemodialysis Patients

Abstract

BackgroundSeroconversion following Hepatitis B virus (HBV) vaccine in hemodialysis (HD) patients has been shown to be suboptimal. Nutritional and immunological factors were shown to influence the seroconversion related to HBV vaccination in HD patients. Resistance to erythropoiesis stimulating agents (ESA) for correction of anemia has also been shown to be associated with nutrition and inflammation in these patients.ObjectivesThe aim of the current study was to analyze the relationship between anti-HBs response and erythropoietin (EPO) resistance in HD patients.Patients and MethodsDemographics, clinical characteristics, laboratory parameters and the data about vaccination status were obtained from dialysis charts and vaccination registries retrospectively. To calculate the EPO resistance ESA hypo responsiveness index (EHRI) was used. The EHRI was calculated through deviding the weekly dose of EPO by per kilogram of body weight divided by the hemoglobin level. Patients were divided into non-seroconversion (anti-HBs titers were < 10 IU/L) and seroconversion groups (anti-HBs titers were ≥ 10 IU/L) after completion of the four-dose vaccination schedule.ResultsIn total 97 patients were enrolled. For the entire group, stepwise linear regression analysis revealed that square root transformed anti-HBs levels were independently associated with age (P = 0.016), blood urea nitrogen (P = 0.019), high sensitive C-Reactive Protein (P = 0.009), and square root transformed EHRI (P = 0.019). Logistic regression analysis have also demonstrated that blood urea nitrogen (P = 0.002), creatinine (P = 0.046), albumin (P = 0.01) and square root transformed EHRI (P = 0.011) were independently related to seroconversion.ConclusionsEPO resistance was negatively associated with anti-HBs levels and seroconversion. More studies are needed to highlight the underlying mechanisms regarding EPO resistance and response to HBV vaccination in HD patients.

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

“…Development of anti-EPO antibodies resulting in severe aplasia and transient alterations in RBC rheology have also been reported (55). Furthermore, some patients appear to have “EPO resistance”, possibly secondary to malnutrition and inflammation (56). For these reasons, its expense, and possible link to thromboembolic events and tumour growth via promotion of angiogenesis, the National Institute for Health and Care Excellence (NICE) guidelines warn against routine use of rEPO except in patients who decline blood transfusion or if transfusion is unavailable due to presence of alloantibodies (57).…”

Hepatitis B Vaccination: Needs a Revision

“…Anemia is a common finding among patients who undergo HD which is usually corrected by human recombinant erythropoietin (EPO). In a series of 97 patients, resistance to EPO was associated with lower anti-HBs levels and seroconversion ( 22 ). It seems to be partly due to poor nutrition status and inflammation in these individuals ( 22 ).…”

“…In a series of 97 patients, resistance to EPO was associated with lower anti-HBs levels and seroconversion ( 22 ). It seems to be partly due to poor nutrition status and inflammation in these individuals ( 22 ). However, Fabrizi and his colleagues found that EPO injection has no effects on the HBV vaccination in patients who undergo HD ( 14 ).…”

In Reply to "The Relationship Between Erythropoietin Resistance and Antibody Response to Hepatitis B Vaccine in Hemodialysis Patients"

“…He analyzed the relationship between anti-HBs response and erythropoietin (EPO) resistance among patients undergoing maintenance hemodialysis and demonstrated that EPO resistance is negatively associated with both anti-HBs levels and seroconversion status among these patients (1). …”

“…We read with great interest the article by Baris Afsar entitled "The relationship between erythropoietin resistance and antibody response to hepatitis B vaccine in hemodialysis patients" published in your valuable journal. He analyzed the relationship between anti-HBs response and erythropoietin (EPO) resistance among patients undergoing maintenance hemodialysis and demonstrated that EPO resistance is negatively associated with both anti-HBs levels and seroconversion status among these patients ( 1 ).…”