Factors Influencing the Response to Hepatitis B Vaccination of Hemodialysis Patients

Abstract

The response rate and HBsAG antibody concentrations were examined after hepatitis B vaccination in 78 hemodialysis patients aged between 29 and 79 years. The values were related to age, duration of hemodialysis, body weight, creatinine, urea nitrogen, serum concentrations of β₂-microglobulin and soluble interleukin-2 receptor (IL-2R). Patients with low anti-HBsAG antibody concentrations (10–100 mU/ml) had significantly higher IL-2R serum concentrations than those with high anti-HBsAG antibody concentrations ( > 3,000 mU/ml; p < 0.05). Discriminant multivariate analysis (p = 0.032) revealed the influence (62%) of IL-2R on the response rate while other factors were similar in all patient groups. It is concluded that preactivation of T cells with an increased release of IL-2R may contribute to impaired immune response after hepatitis B vaccination.

Epidemiology of Viral Hepatitis in Dialysis Centers: A National Survey

“…The results too are striking: of a total of 7,790 patients, an 'efficacious' seroconversion (>I0 U/m l) was obtained in 4,626 cases, i.e., 57.9%, in keeping with other authors' reports [3,12,13,34,45]. Unfortunately, we did not ask for information on the age of the responders, and so we cannot confirm whether the antibody response depends, at least partially, on this pa rameter [10,38], even if a recent paper by Walz [45] would tend to rule this out.…”

“…However, the true key to success in the fight seems to be the anti-HBV vaccine. After results proving more than 95% efficacy in the nonuremic population [10,47], the use of this method is spreading, even if its high cost (about 150 US S per cycle); the possible lack of response in subjects with elevated levels of interleukin-2 receptor [45], or even the appearance of H B V mutants [5], lead to consider that it may be wiser to use the vaccine in the high-risk sectors of the population, where the results are nevertheless posi tive [11,12,34,39], The uremic patient, whether undergoing dialysis or not, is certainly subject to risk, and in this field, in fact, the use of the vaccine is steadily increasing. For example, in the USA, in 1982, only 17% of centers [39] made use of this vaccine, but just 1 year later, 71% of centers provided vaccination for their dialysis staff and 43% for their patients.…”

Evaluation of a Region-Wide Hepatitis B Vaccination Program in Dialysis Patients: Experience in an Italian Region

“…sex, length of time on dialysis, underlying pathologic condition, type of vaccine, dosages, schedules [16][17][18][19][20]. In our study, no data on pathologic conditions were col lected; the two vaccinated groups were similar in most relevant characteristics but not in length of time on dialy sis.…”

Immunization and Vaccination Protocol in Hemodialysis Patients with Naturally Acquired Hepatitis B Antibody

“…According to our own and others' experience [2], antiHBs-negative patients, after intensive vaccination proto cols, maintained significant anti-HBs levels with yearly booster doses. A different evolution of naturally acquired anti-HBs levels is shown in our patients: most of them (15 of 22) maintained protective antibody concentration throughout follow-up, and the other 7, after a single booster dose of vaccine, showed a proportion of seroconversion similar to that observed after the full schedule in anti-HBsnegative patients.…”