Hepatitis B Vaccination in Chronic Kidney Disease: Review of Evidence in Non-Dialyzed Patients

Abstract

ContextHepatitis B vaccination of hemodialysis patients is performed all over the world. There are also recommendations from world health organizations to vaccinate patients with chronic kidney disease (CKD) prior dialysis commencement, but the implementation of a hepatitis B vaccination program is less common and not well organized.Evidence AcquisitionThis review article summarizes data indicating why, when and how to vaccinate CKD patients before they start renal replacement therapy. Publication for this review was bringing into being from PubMed.ResultsThere is an agreement in the nephrological societies and among clinicians and scientists that CKD patients should be vaccinated in early stages of their disease, because a higher glomerular filtration rate is more likely to be associated with the responsiveness to vaccination. Schedules of vaccination and optimal vaccine doses are still being investigated. Differences in data with respect to these problems may result from comparisons of various vaccine doses and vaccination schedules without reference to one gold standard, variations in patients` clinical status and glomerular filtration rate, and also the small groups of the affected patients make statistical analysis non-conclusive. A titer of antibodies to surface antigen of hepatitis B virus (anti-HBs) > 10 IU/L or ≥ 10 IU/L is commonly considered as a marker of seroconversion to anti-HBs positivity after vaccination in both non-dialyzed and dialyzed patients. In advanced CKD, vaccine–induced serconversion rate is seldom observed in more than 90% of vaccinees. Various strategies have been utilized in order to increase vaccine-induced seroconversion rate in patients with advanced CKD. Changing the injection mode, the use of adjuvants and immunostimulants to improve the immunogenicity of existing recombinant hepatitis B vaccines, introduction of mammalian-cell derived pre-S/S HBV vaccines (third-generation vaccines) were tried in order to improve the immunization rate.ConclusionsThere are a substantial number of non-responders to the hepatitis B vaccine among CKD patients. Therefore, successful prevention of hepatitis B virus transmission and spread will only be attained when hepatitis B vaccination is applied together with full implementation of appropriate infection control procedures.

Titers of antibodies to the surface antigen of hepatitis B virus after vaccination in relation to immunity-related gene variants. A prospective study among hemodialysis patients

“…23 As the subject of this study concerns maximum anti-HBs titers, it is important to note that only 1% of the patients obtained their peak anti-HBs levels prior to dialysis onset. Nowadays, after the introduction of compulsory HBV vaccination of children, the rate of HBV-vaccinated pediatric patients before dialysis onset reaches 68%.…”

Prophylactic vaccinations in chronic kidney disease: Current status

“…That is the reason that HBV vaccination was formerly recommended at lower GFR categories. [7][8][9] However, "Kidney Disease: Improving Global Outcomes (KDIGO) CKD" Work Group recommends that all adults at high risk of progression of CKD (GFR categories G4-G5) should be immunized against hepatitis B, and the response confirmed by appropriate serological testing (grade 1B). 34 The recent recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) also indicate a need for advanced vaccination strategy for adults with GFR categories G4-G5.…”

“…6 Effects of active immunizations of CKD patients attract attention of clinicians and pharmaceutical agencies, and are systematically summarized and evaluated. [7][8][9] The objective of this review is to announce advances in recognition of immunocompromised state in CKD patients, novel issues concerning prophylactic vaccinations against hepatitis B virus, influenza, pneumococci and other microbes in this group as well as progress in development of hepatitis C vaccine which is crucial for patients with altered immunocompetence, especially those receiving maintenance extracorporeal dialysis therapy. In this review, I am focusing only on data published in the last 5 y.…”

A Review of Chronic Kidney Disease and the Immune System: A Special Form of Immunosenescence

“…Other vaccines, such as hepatitis B and pneumococcal vaccines, require more frequent and/or higher doses to produce and maintain protective antibody levels [82]. CKD patients should be vaccinated in early stages of their disease, because a high GFR is more likely to be associated with the responsiveness to vaccination, particularly with the hepatitis B vaccine [83,84]. The majority of CKD patients produce a good antibody response to the pneumococcal capsular polysaccharide vaccine (PPV23); however, a substantial proportion of patients fail to mount an adequate antibody response to PPV23 and remained at significant risk of pneumococcal infection [85].…”