Antibody response to hepatitis B vaccine in end-stage renal disease patients.
BACKGROUND
This retrospective and comparative study evaluated the relationship between different factors which may contribute to suboptimal immunological response to intramuscular recombinant hepatitis B vaccine in end-stage renal disease (ESRD) subjects.


METHODS
From a cohort of 64 dialysis subjects undergoing primary vaccination with Engerix-B, we determined the predictive factors that impinged on patients' response to vaccine, as defined by anti-HBs level > or = 10 mIU/l. Dose efficacy was further evaluated by comparing three historical cohorts vaccinated by the regimens of 20, 40 and 80 microg/dose, respectively.


RESULTS
We identified 64 ESRD patients (mean age 43 +/- 12 years, 81% receiving peritoneal dialysis) who received primary vaccination from April 1997 to September 2004. Median follow-up was 6.5 years. They achieved 81% seroconversion rate. Older age, diabetes mellitus, obesity and low Engerix-B dose were risk factors of inadequate anti-HBs response by univariate analysis. By stepwise logistic regression analysis, hepatitis B vaccine dose was the only independent predictive factor of impaired antibody response. An Engerix-B vaccine dose of 20 microg was associated with more than tenfold increase in risk of non-response to hepatitis B vaccine (hazards ratio 32.2 (95% CI 3.85-250.0)). Immunization with 80 microg of Engerix-B increased the likelihood of persistent protective antibody (log-rank test, p = 0.014). Immunization with Engerix-B 80-microg dose is estimated to prevent one extra ESRD subject who would lose seroprotective anti-HBs level at 1 year for every 5.6 patients treated (number needed to treat to benefit, 5.6 (95% CI 5.4-5.8)).


CONCLUSIONS
Our results suggest the potential for the three-dose schedule of recombinant vaccine Engerix-B 80 microg to prolong the immune response among ESRD population.
Chow
Kai Ming
KM
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China. Chow_Kai_Ming@alumni.cuhk.net
Law
Man Ching
MC
Leung
Chi Bon
CB
Szeto
Cheuk Chun
CC
Li
Philip Kam-Tao
PK
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control* / Q000628:therapy; D006510:Hepatitis B Antibodies / Q000096:biosynthesis* / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014611:Vaccination; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000627:therapeutic use*
C075654:Engerix-B; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic