A Study on the Protection of Hemodialysis Patients Against Diphtheria and Tetanus

Abstract

Patients with end stage renal disease suffer from a high incidence of infectious diseases believed to be related to their impaired immune system. To determine the antitetanus and antidiphtheria IgG antibody levels in Iranian hemodialysis patients with end stage renal disease, as well as its association with sex, age, hemoglobin, zinc serum level, serum albumin, duration of dialysis, number of dialysis per week, dialysis adequacy, erythropoietin or iron supplements such as venofer, body mass index (BMI), and underlying renal disorder, we conducted a crosssectional study on a total of 112 hemodialysis patients with end stage renal disorder (60 male, 52 female ) and 36 healthy individuals in the control group (14 male, 22 female). The patients and the control group received no antitetanus or antidiphtheria vaccine or immunoglobulin in the year prior to the investigation. The serum antitetanus and antidiphtheria IgG antibody levels were measured using the ELISA method. We found out that only 16% of our hemodialysis patients were immune to diphtheria (19% of the control group), and this rate for tetanus was 24% (48.2% in the healthy control). Except for the hemodialysis duration, none of the mentioned factors seemed to affect immunity. We conclude that in our study, the level of the antitetanus IgG antibody (unlike the antidiphtheria IgG antibody level) is significantly different among the hemodialysis patients, the chronic hemodialysis patients, and the control group.

Immunity to Diphtheria in Haemodialysis Patients

“…Also there was not statistically meaningful difference between the protected against diphtheria patients (n = 11) and those not protected (n = 41). The same results were showed by (Sagheb et al 2009). …”

“…Therefore 34 (65.40%) patients were not protected against diphtheria because their IgG less than 0.1 IU mL −1 (Cameron et al, 2009;Sagheb et al 2009). Table 1 illustrates the characteristics of the patients and the control groups.…”

“…A few studies were done on immunization against anti-diphtheria in patients with chronic renal failure (Kruger et al, 1999;Kreft et al, 2000;Sagheb et al, 2009). Diphtheria protected individuals in the patients group were significantly less than tetanus protected individuals in the control group (21.15% Vs 2.70%) (p = 0.011).…”

“…Optical density was measured at 450 nm using ELISA reader (Awerness Instruments, USA). Based on the EPI Program of WHO, the assay cut-offs for protective level of tetanus antibody was set at 0.1 International Units (IU mL  1 ) (Sagheb et al, 2009;(Olander et al, 2009). Concentrations above the assay cut-offs were considered to be seroprotective.…”

“…These vaccinations have decreased the incidence and changed the epidemiology of these diseases (Zarei et al, 2007), but there is no routine vaccination for hemodialysis patients and So far only a few studies have focused on seroresponse to tetanus toxoid in these patients in Iran (Sagheb et al, 2009;Jahromi et al, 2009).…”