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

Abstract

<b><i>Background:</i></b> 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. <b><i>Aim:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>Q</i> = 14.147). Stratified analysis in various subgroups of interest did not significantly change these findings. <b><i>Conclusions:</i></b> 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.

Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

“…Oster et al also reported that EPO treatment is associated with an improved immune response to influenza vaccine in hematologic patients, with titers similar to those of healthy subjects, although they did not examine the renal function of the patients (63). However, a meta-analysis of 11 studies failed to detect any benefit of EPO treatment regarding the response to HBV vaccine (64). Therefore, the role of EPO treatment in improving the function of DCs and their responsiveness to HBV vaccine remains to be elucidated.…”

Hepatitis B Vaccination: Needs a Revision

“…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). …”

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis

“…However, clinical trials have also proposed several other factors having predictive values in this era; but due to the controversial evidence provided by different reports, systematic reviews and metaanalyses have been conducted to pool data of all the published trials to provide a thorough conclusion from the cumulative data. Most of the published systematic reviews on this subject have been performed by Fabrizi et al [31] investigating potential effects of a large number of factors on HBV vaccination in dialysis patients. For example they found no significant effects for using erythropoetin (Epo) [31] and some other adjuvants [32] on the immunogeneity of HB vaccination in kidney disease patients; while several other factors significantly associated with seroconversion have also been reported by the same authors that included use of levamisole [33] , granulocyte macrophage-colony stimulating factor [32] and thymopentin use [34] .…”