Factors associated with long-term antibody production induced by hepatitis B vaccine in patients undergoing hemodialysis: a retrospective cohort study.
OBJECTIVE
To assess the influence of various clinical factors on antibody production induced by hepatitis B vaccine in patients receiving hemodialysis up to 24 months after vaccination.


METHODS
Retrospective cohort study.


METHODS
Outpatient dialysis center.


METHODS
Adult patients undergoing hemodialysis who received a three-dose series of intramuscular hepatitis B vaccine 40 microg at time 0, 1, and 6 months, according to protocol.


RESULTS
Antibody to hepatitis B surface antigen (anti-HBs) titers were monitored quarterly, and booster doses were given according to protocol. Patients with anti-HBs of at least 10 mIU/ml were considered seropositive. Clinical variables--age, diabetes mellitus status, serum albumin level, and equilibrated Kt/V (eKt/V; Kt/V is a measure of urea clearance during dialysis, used to quantify the delivered dose of hemodialysis)--were compared between seropositive and seronegative patients 12 months (cohort 1) and 24 months (cohort 2) after vaccination. In cohort 1 (66 patients), 24 (36.4%) were seropositive at 12 months. In cohort 2 (40 patients), 15 (37.5%) were seropositive at 24 months. Comparison of seropositive and seronegative patients revealed no statistically significant differences in mean age, sex, serum albumin level, or eKt/V. However, at 24 months, patients with diabetes were 2.5 times more likely to demonstrate seropositivity than those without diabetes (60% vs 24%, respectively, p=0.02).


CONCLUSIONS
Long-term seroprevalence induced by hepatitis B vaccine was low in our patients 12 and 24 months after vaccination. These results were comparable to previously reported long-term results. Larger, prospective studies would be needed to confirm the finding that patients with diabetes had superior hepatitis B vaccine-induced antibody production at 24 months.
Elwell
Rowland J
RJ
Department of Pharmacy Practice, Albany College of Pharmacy Albany, New York 12208, USA. elwellr@acp.edu
Neumann
Marianne
M
Bailie
George R
GR
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000096:biosynthesis* / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012737:Sex Factors
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines