Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy

Abstract

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.

No Improvement of Hepatitis B Vaccination Response in Patients Dialysed with a Polymethylmethacrylate Membrane Compared to High-Flux Polysulfone: Results of the HEPADIAL Study

“…Finally, we found no differences between responders and non-responders for parameters usually reported as factors of poor vaccine response [3,4,17,18]. Non-responder patients are older as previously reported in the literature [18,19], but the difference is not significant probably due to lack of power.…”

Does infection by the C hepatitis virus reduce the vaccine response for the B hepatitis virus among a population under dialysis?

“…The pathogenesis of this trait was recently reviewed by Sit et al 17 and has been attributed to a series of variables such as genetic characteristics, nutritional factors, vaccine dosages and route of administration, stage of CKD, diagnosis of diabetes mellitus, time on dialysis, dialysis adequacy, co-infection by HIV or HCV, and others.…”

An Investigation of the Immune Response to Hepatitis B Vaccination in Hemodialysis Patients at Dialysis Centers of Tehran (2016)

“…There was no association between gender and the rate of the response to the HB vaccine. Different results have been reported for the relationship between these two variables in various studies, with positive correlations reported in some studies [9,[15][16][17] and negative correlations in some others [1,3]. These differences could be explained by intrinsic differences between men and women in their ability to respond to superficial hepatitis antigens.…”