Antibody level after hepatitis-B vaccination in hemodialysis patients: impact of dialysis adequacy, chronic inflammation, local endemicity and nutritional status.
We prospectively studied the evolution of HBsAg antibody (HBsAb) after primary vaccination (four doses; Engerix B, 40 pg i.m at 0, one, two and six months) in 29 patients who were seronegative (HBsAb <10 IU/L), had not been previously vaccinated and were on hemodialysis. Their mean age was 45.58 +/- 10.98 years, and the hemodialysis duration ranged from 1-21 years. In addition, we assessed dialysis adequacy for all cases on four different occasions beside the estimation of predialysis serum albumin, serum ferritin, C-reactive protein (CRP), transferrin saturation ratio (TSAT), body mass index (BMI) and subjective global assessment (SGA). We measured anti-HBs titer eight weeks after the fourth dose. Our results showed that two patients (6.90%) were nonresponders (HBsAb <10 IU/L) after the completion of vaccination. One patient (3.45%) was a weak responder (10-100 IU/L). Strikingly, 26 patients (89.65%) showed good antibody response (>100 IU/L). HBsAb titers showed no significant correlation with age, duration of HD therapy, serum albumin, CRP, TSAT level, BMI or SGA scores (p > 0.05). Responders to primary vaccination had significantly higher levels of urea reduction ratio (%) and Kt/V compared to nonresponders (63.61 +/- 6.97% and 1.25 +/- 0.15 vs. 52.0 +/- 2.10% and 0.92 +/- 0.13, respectively, P < 0.05). In conclusion, this was a preliminary study showing a very high response to hepatitis-B vaccination among hemodialysis patients that neither correlated with age, systemic inflammation nor nutritional status. Efficient hemodialysis was associated with good response to hepatitis-B vaccine.
Ibrahim
Salwa
S
Department of Medicine, King Fahad Renal Unit, Cairo University, Egypt. salwaibrahim@hotmail.com
el-Din
Sharaf
S
Bazzal
Ibrahim
I
D000328:Adult; D002908:Chronic Disease; D004534:Egypt; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D007249:Inflammation / Q000276:immunology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011446:Prospective Studies; D006435:Renal Dialysis; D014611:Vaccination
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines