The effect of erythropoietin therapy and hemoglobin levels on the immune response to Engerix-B vaccination in chronic kidney disease.
BACKGROUND
Patients undergoing chronic hemodialysis have an increased risk of acquiring hepatitis B infection. Only 43-66% of dialysis patients develop effective anti-HBs titers after vaccination.


OBJECTIVE
To evaluate the effect of recombinant erythropoietin (rEPO) therapy and basal hemoglobin levels on the outcome of the immune response to four doses of IM 40 microg Engerix-B vaccination in hemodialysis and chronic kidney disease (CKD) patients before starting replacement therapy.


METHODS
One hundred and three patients were included in the study: 34 hemodialysis patients treated with rEPO (Group A), 36 predialytic patients who did not treated with rEPO (Group B) and 33 predialytic patients treated with rEPO (Group C). Plasma creatinine in predialytic patients was 2-7 mg/dL. All patients' HBsAg and anti-HBs antibodies were negative. Patients were immunized with IM 40 microg Engerix-B at 0, 1, 3, and 6 months. Anti-HBs titers were measured at 7th month.


RESULTS
Eighty seven point one percent of patients from group C developed protective anti-HBs titers compared with 69.4% from group B and 44.1% from group A (p = 0.001). Patients from all groups with baseline hemoglobin levels above 11 gr/dL developed protective anti-HBs titers significantly more than patients with baseline hemoglobin levels below 11 gr/dL (p < 0.05).


CONCLUSIONS
Predialytic patients treated with rEPO and with hemoglobin levels higher than 11 gr/dL had significantly better immune response outcomes to Engerix-B vaccination. Immunization against hepatitis B infection should be considered at early stages of CKD prior to the deterioration in kidney functions and the development of renal anemia.
Hassan
Kamal
K
Nephrology and Hypertension Department, Western Galilee Hospital, Nahariya, Israel. drkamalh@hotmail.com
Shternberg
Lev
L
Alhaj
Mohamad
M
Giron
Ronit
R
Reshef
Ron
R
Barak
Mira
M
Kristal
Batya
B
D000368:Aged; D002908:Chronic Disease; D015941:Complement Hemolytic Activity Assay; D004921:Erythropoietin / Q000276:immunology / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000187:drug effects / Q000276:immunology* / Q000378:metabolism*; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D018937:Hepatitis C Antibodies / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D006801:Humans; D007109:Immunity / Q000187:drug effects*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000276:immunology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis; D013223:Statistics as Topic; D016896:Treatment Outcome; D014611:Vaccination; D014614:Vaccines, Synthetic / Q000187:drug effects* / Q000276:immunology / Q000627:therapeutic use*
C075654:Engerix-B; D006454:Hemoglobins; D017325:Hepatitis B Vaccines; D018937:Hepatitis C Antibodies; D011994:Recombinant Proteins; D014614:Vaccines, Synthetic; D004921:Erythropoietin