title: Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better.
abstract: BACKGROUND
  Hepatitis B virus (HBV) infection remains a concern in dialysis populations, and vaccination programs have been less successful than those in the general population. Reasons for poor response include malnutrition, uremia, and the generalized immunosuppressive state of patients with chronic kidney disease (CKD). This prospective cohort study evaluated factors impacting on the effectiveness of a vaccination program before dialysis therapy initiation, including level of kidney function.
  
  
  METHODS
  All patients receiving care in the Kidney Function Clinic (St Paul's Hospital, Vancouver, Canada) were screened for previous HBV infection or vaccination. Those who were marker negative were administered a standardized hepatitis B vaccination schedule recommended for patients with CKD. The primary outcome measure, seroconversion, is defined as hepatitis B surface antibody titer greater than 10 IU 3 months after completion of the vaccination schedule.
  
  
  RESULTS
  The study population of 165 patients included 64% men with a mean age of 60 years, mean serum creatinine level of 3.4 +/- 1.5 mg/dL (300 +/- 133 micromol/L), and median estimated glomerular filtration rate (GFR) of 20 mL/min (interquartile range, 14 to 20). Seroconversion rate was 82%. Multivariate analyses showed the independent predictive value of level of GFR. The model showed that patients with the lowest level of kidney function and who were older and had diabetes were less likely to seroconvert (P < 0.05).
  
  
  CONCLUSIONS
  This is the largest study to show in a well-characterized cohort that patients with higher GFR levels are more likely to respond to hepatitis B vaccination programs with seroconversion, independent of other factors. Future studies will explore specific mechanisms to explain this phenomenon.
authors.affiliation: Division of Nephrology, Kidney Function Clinic, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: DaRoza
authors.forename: Andrea
authors.initials: A
authors.lastname: Loewen
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: Janet
authors.initials: J
authors.lastname: Love
authors.forename: Cathy
authors.initials: C
authors.lastname: Kempston
authors.forename: Shelley
authors.initials: S
authors.lastname: Burnett
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
authors.forename: Paul A
authors.initials: PA
authors.lastname: Taylor
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000276:immunology; D005260:Female; D005919:Glomerular Filtration Rate; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000096:biosynthesis*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D007676:Kidney Failure, Chronic / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D014611:Vaccination
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D003404:Creatinine