Recombinant Hepatitis B Vaccine Use in Chronic Hemodialysis Patients

Abstract

The prevalence of hepatitis B virus (HBV) infection in our unit was 45% (86/190): there were 77 (40.5%) and 9 (4.7%) patients with previous and persistent HBV infection, respectively. Recombinant hepatitis B vaccine was given to 118 chronic HD patients with a regimen of 3 double doses administered intramuscularly at 0, 1 and 2 months, obtaining a seroprotection rate of 67% (79/118), 57% (45/79) being high responders. At month 24, 78% (40/51) maintained protective levels of anti-HBs, 45% (18/40) of them being high responders. There was a statistically significant difference between responder and non-responder patients with regard to nutritional parameters such as serum total proteins and mean levels of transferrinemia. The number of diabetic patients was significantly increased in the nonresponder group. Patients with persistent antibodies (‘persistent responders’) were younger and had a shorter duration of HD treatment compared to those responders who rapidly lost anti-HBs (‘transient responders’). Serological positivity for antibodies against hepatitis B core antigen significantly facilitates the decrease of anti-HBs antibodies over time. We detected seven episodes of HBV infection among HD patients at our unit before the beginning of the vaccination program. On the contrary, there were no episodes of HBV infection among responder vaccinees during the 24-month follow-up period. After the initial cost of vaccination, a savings of US$ 3,272 per year was realized by the elimination of frequent serologic screening of vaccine responders.

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

“…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]. Liu et al [36] observed an increment of anti-HBs titers between the initial month and the seventh month, related to rHuEPO dosage, in the control group only.…”

“…Various approaches have been suggested in order to improve the response rate to hepatitis B vaccine in dialysis populations including increased vaccine doses [35] or shots, or intradermal vaccine route [38,39]. Higher immunogenicity has been observed when HBV vaccine has been given to CKD patients not yet requiring regular dialysis [19].…”

Efficacy and Safety of Reinforced Versus Standard Vaccine Schedule Towards Hepatitis B In Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…They have lower seroprotection rates compared with healthy subjects; moreover, after completion of vaccination schedule anti-HBs titers of responder uraemic patients are low and decline logarithmically over time (1). Various approaches have been made to overcome the non-responsiveness of chronic uraemic patients including co-administration of adjuvants (8), or immune modulators (9), intradermal administration of HB vaccine (10), increased vaccine doses, or additional inoculations (11). Alternatively, it has been recommended to start vaccination in the early stages of a renal disease (12), when one could anticipate that the primary immune response is still satisfactory.…”

Viral Hepatitis Infections in Chronic Kidney Disease Patients and Renal Transplant Recipients

“…The standardized recommended (and even cost-effective) vaccination schedule for CKD or hemodialyzed patients consists of the intramuscular administration of 40 µg of recombinant vaccine (double the dose for the general population) at 0, 1, and 6 months [61]. The seroprotective titer of anti-HBs antibody is 10 IU/l.…”