Efficient Haemodialysis Improves the Response to Hepatitis B Virus Vaccination

Kovačić, Vedran; Šain, Milenka; Vukman, V.

doi:10.1159/000065873

Cited by 34 publications

(25 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In their observational study on 105 patients on maintenance HD, Eardley et al [33] observed no significant difference in mean rHuEPO dose between responder and non-responders dialysis patients after a primary course of vaccine [6,495 vs. 6,171 IU/week (p = 0.66)]. Identical results were obtained by Kovacic et al [34]. No link between seroresponse rate and rHuEPO therapy, as assessed by rate of rHuEPO administration between responder and non-responder patients, was noted after the HBV vaccine schedule in another cohort study [35].…”

Section: Discussionmentioning

confidence: 73%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 73%

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

View full text Add to dashboard Cite

show abstract

“…We could assume that inefficient dialysis and longer duration of dialysis weakened the immune response further, resulting in a poor immune response. Previously, Kovacic et al [17] reported that efficient HD significantly improves the response to hepatitis B vaccination. These authors showed that good responders had a better Kt/V than poor responders.…”

Section: Discussionmentioning

confidence: 99%

Active Influenza Immunization in Hemodialysis Patients: Comparison between Single-Dose and Booster Vaccination

Song

Cheong

et al. 2006

Am J Nephrol

View full text Add to dashboard Cite

Background/Aims: Hemodialysis (HD) patients are recommended to be immunized against influenza annually, but the immune response after vaccination is known to be weakened in these patients. We intended to compare the efficacy of influenza vaccines in HD patients with that in healthy people, and we also evaluated the additive effect of a booster vaccination in HD patients. Methods: During the 2003–2004 influenza season, 100 patients on HD and 50 age-matched healthy controls were recruited from the Korea University Guro Hospital. The HD patients were divided into two groups: single-dose group (50 patients) and booster group (50 patients). Eight weeks following the influenza vaccination, the serum antibody responses were compared. Results: Although the antibody response of the HD patients was impaired in comparison with that of healthy controls, more than 90% of the HD patients showed protective antibody levels. Booster vaccination did not significantly increase the immune response in HD patients. Conclusions: Influenza vaccination in HD patients should be encouraged, but the immune response was comparatively impaired in subpopulations, including patients with a long-term HD history (>2.5 years), with a higher urea reduction rate, or with underlying diabetes. There was no effect of a booster vaccine dose on the antibody titers.

show abstract

“…The hepatitis B antibody response rate had also been shown to diminish with increasing severity of renal failure [14, 15] and ineffective dialysis [16]. Thus, one of the plausible reasons for the lower response rate among the overweight subjects could have been related to their inadequate dialysis, in particular with majority of them undergoing peritoneal dialysis.…”

Section: Discussionmentioning

confidence: 99%

Antibody Response to Hepatitis B Vaccine in End-Stage Renal Disease Patients

Chow¹,

Law²,

Leung³

et al. 2006

Nephron Clin Pract

View full text Add to dashboard Cite

Background: This retrospective and comparative study evaluated the relationship between different factors which may contribute to suboptimal immunological response to intramuscular recombinant hepatitis B vaccine in end-stage renal disease (ESRD) subjects. Methods: From a cohort of 64 dialysis subjects undergoing primary vaccination with Engerix-B^®, we determined the predictive factors that impinged on patients’ response to vaccine, as defined by anti-HBs level ≧10 mIU/l. Dose efficacy was further evaluated by comparing three historical cohorts vaccinated by the regimens of 20, 40 and 80 µg/dose, respectively. Results: We identified 64 ESRD patients (mean age 43 ± 12 years, 81% receiving peritoneal dialysis) who received primary vaccination from April 1997 to September 2004. Median follow-up was 6.5 years. They achieved 81% seroconversion rate. Older age, diabetes mellitus, obesity and low Engerix-B dose were risk factors of inadequate anti-HBs response by univariate analysis. By stepwise logistic regression analysis, hepatitis B vaccine dose was the only independent predictive factor of impaired antibody response. An Engerix-B vaccine dose of 20 µg was associated with more than tenfold increase in risk of non-response to hepatitis B vaccine (hazards ratio 32.2 (95% CI 3.85–250.0)). Immunization with 80 µg of Engerix-B increased the likelihood of persistent protective antibody (log-rank test, p = 0.014). Immunization with Engerix-B 80-µg dose is estimated to prevent one extra ESRD subject who would lose seroprotective anti-HBs level at 1 year for every 5.6 patients treated (number needed to treat to benefit, 5.6 (95% CI 5.4–5.8)). Conclusions: Our results suggest the potential for the three-dose schedule of recombinant vaccine Engerix-B 80 µg to prolong the immune response among ESRD population.

show abstract

Efficient Haemodialysis Improves the Response to Hepatitis B Virus Vaccination

Cited by 34 publications

References 23 publications

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

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

Active Influenza Immunization in Hemodialysis Patients: Comparison between Single-Dose and Booster Vaccination

Antibody Response to Hepatitis B Vaccine in End-Stage Renal Disease Patients

Contact Info

Product

Resources

About