Response to the hepatitis B virus vaccine in haemodialysis patients: influence of malnutrition and its importance as a risk factor for morbidity and mortality.
OBJECTIVE
To assess if malnutrition influences the response to the hepatitis B virus vaccine in haemodialysis patients and whether this correlates with morbidity and mortality in these patients.


METHODS
A 4-year prospective open study.


METHODS
Haemodialysis unit of a 434-bed University Hospital.


METHODS
Sixty-four patients with end-stage chronic renal failure on maintenance haemodialysis.


METHODS
Three-dose vaccination series with recombinant hepatitis B virus vaccine.


METHODS
Antibody formation against the vaccine, predialysis serum urea, serum albumin and prealbumin, dialysis efficacy (Kt/V), protein catabolic rate (PCR), arm muscle circumference, triceps skinfold, serum parathyroid hormone concentration, mortality and morbidity (hospital days per year of dialysis).


RESULTS
Increase in age negatively influences the formation of antibodies (P = 0.01), whereas serum albumin (P = 0.008) and predialysis blood urea concentration (P = 0.004) are positively correlated with the formation of antibodies. Responders had significantly higher levels of serum albumin and prealbumin and predialysis blood urea than non-responders. The percentage of non-responders was higher (70%) in the group with predialysis blood urea concentration between 90 and 125 mg/dl than in those with predialysis blood urea concentrations between 176 and 225 mg/dl (14.2%). Patients with serum albumin levels between 3 and 3.5 g/dl were non-responders in a higher percentage (87.5%) than those with serum albumin levels between 4.5 and 5 g/dl (18.8%). After a 4-year follow-up, survival was 20% higher in the responder group (P < 0.05). Morbidity, expressed as hospital days per year of haemodialysis, was markedly lower in the responder group (10.4 +/- 2 versus 32 +/- 14 days, P = 0.03).


CONCLUSIONS
Malnutrition negatively influences the response to the hepatitis B virus vaccine in haemodialysis patients. Non-responders have higher morbidity and mortality than responders, and therefore the absence of response to the hepatitis B vaccine can be considered as a risk factor in the haemodialysis population.
Fernández
E
E
Nephrology Service, University Hospital Arnau de Vilanova, Lleida, Spain.
Betriu
M A
MA
Gómez
R
R
Montoliu
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009748:Nutrition Disorders / Q000150:complications / Q000503:physiopathology*; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D014508:Urea / Q000097:blood; D014765:Viral Vaccines / Q000627:therapeutic use*
D011228:Prealbumin; D012709:Serum Albumin; D014765:Viral Vaccines; D014508:Urea