Incidence and Clinical Predictors of Nonresponse to Hepatitis B Vaccination among Patients Receiving Hemodialysis: Importance of Obesity.
OBJECTIVE
The objectives of this study were to quantify the incidence of hepatitis B virus (HBV) vaccine nonresponse and identify clinical characteristics associated with vaccine nonresponse.


METHODS
A retrospective cohort study was conducted among patients undergoing hemodialysis (HD) receiving the HBV vaccine. Study inclusion criteria were age 18 years and older, receipt of HD treatment for ≥ 1 month, receipt of ≥ 1 dose of HBV vaccine, availability of anti-HB surface antibody (anti-HBs) laboratory values ≥ 2 weeks after last HBV vaccine, and prevaccine anti-HBs value <10 mIU/mL. Clinical data were abstracted from patients' medical records. The outcome of interest was vaccine nonresponse, defined as anti-HBs values <10 IU/mL. Multivariate regression was used to determine variables independently associated with vaccine nonresponse. Kaplan-Meier estimates were constructed for determining HBV vaccine response retention.


RESULTS
Of the 119 patients evaluated, nonresponse was observed in 58%. Mean age at first vaccination for vaccine responders and nonresponders was 58.8 ± 16.5 and 65.9 ± 14.1 (P = 0.01), respectively. Variables independently associated with nonresponse were age 58 years and older (adjusted relative risk, 95% confidence interval 1.62, 1.06-2.46; P = 0.02) and body mass index ≥ 36.4 kg/m(2) (adjusted relative risk, 95% confidence interval 1.66, 1.34-2.07; P < 0.01). Among the 50 patients who achieved an initial vaccine response, 26% were not able to maintain vaccine response upon subsequent anti-HBs measurement. The probability of retaining vaccine response over time was significantly modified by body mass index ≥ 25 kg/m(2).


CONCLUSIONS
The frequency of nonresponse to the HBV vaccine was high among patients undergoing HD. The clinical covariates most predictive of vaccine nonresponse were advanced age at the time of vaccination and excess body weight.
From the Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, and the Institute for Health and the Environment, University at Albany, State University of New York, Albany.
Nimish
N
Patel
From the Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, and the Institute for Health and the Environment, University at Albany, State University of New York, Albany.
Magdalene M
MM
Assimon
From the Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, and the Institute for Health and the Environment, University at Albany, State University of New York, Albany.
Emily
E
Bruni
From the Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, and the Institute for Health and the Environment, University at Albany, State University of New York, Albany.
Louise-Anne
LA
McNutt
From the Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, and the Institute for Health and the Environment, University at Albany, State University of New York, Albany.
Darius L
DL
Mason
D000367:Age Factors; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines