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.
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
Kai Ming
KM
Chow
Man Ching
MC
Law
Chi Bon
CB
Leung
Cheuk Chun
CC
Szeto
Philip Kam-Tao
PK
Li
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