title: Effect of vitamin D level on the immunogenicity to hepatitis B vaccination in dialysis patients.
abstract: We undertook this study to assess the response of hepatitis B vaccination in dialysis patients and the effect of vitamin D level on the immunogenicity to hepatitis B vaccination. It was an observational study, which included 60 patients of end-stage renal disease on maintenance dialysis. Patients with anti-HBs antibody positive at baseline were excluded. All received intramuscular recombinant hepatitis B vaccination at 0, 1, 2, and 6 months 20 μg on each deltoid muscle bilateral. Anti-HBs antibody titers were measured at 4 and 7 months of vaccination and the titer ≥10 mIU/mL was considered as "positive". Vitamin D levels were measured at baseline before starting the vaccination. The mean vitamin D level was 15.0 ± 7.8 ng/mL. The vitamin D level <10 and <20 were 23.3% and 83.3%, respectively. The patients on hemodialysis had relatively higher vitamin D level than on peritoneal dialysis patients, i.e. 16.3 ± 8.5 and 11.5 ± 3.1 ng/mL, respectively (p = 0.03). Overall, 38 patients responded to the immunization (63.3%) and 11 patients were non-responders (36.7%) at 4 months. Difference of vitamin D level in responder (16.6 ± 9.1 ng/mL) and non-responder (12.4 ± 4.1 ng/mL) was not significant (p = 0.16). At 7 months (1 month after completion of vaccination) 61.9% were responders and 38.1% were non-responders. The vitamin D level in responders and non-responders were statistically not significant (p = 0.11). In responder, titer ≥100 mIU/mL was seen in 30% at 4 months and in 42.9% at 7 months (p = 0.05). In the good and weak responders at 7 months, vitamin D levels were 21.5 ± 10.8 and 10.1 ± 3.7 ng/mL, respectively (p = 0.37). The association of vitamin D level and anti-HBs antibody titer were not significant (r = 0.03 and 95% CI was -0.43 to 0.48, p = 0.89) in those who responded. Most patients on dialysis were vitamin D deficient. Vitamin D levels did not differ between responding and non-responding dialysis patients.
authors.affiliation: Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India. jhorawat2000@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Jhorawat
authors.affiliation: Department of Gastroenterology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Pal
authors.affiliation: Department of Gastroenterology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nijhawan
authors.affiliation: Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Beniwal
authors.affiliation: Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Dhananjai
authors.initials: D
authors.lastname: Agarwal
authors.affiliation: Department of Nephrology, Sawai Man Singh Medical College and Hospital, J L N Marg, Jaipur, 302 004, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003956:Dialysis / Q000009:adverse effects; D005260:Female; D006509:Hepatitis B / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D000071497:Immunogenicity, Vaccine / Q000276:immunology*; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D014614:Vaccines, Synthetic; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000209:etiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic; D014807:Vitamin D
keywords: End-stage renal disease; Hepatitis B vaccination; Immunogenicity; Vitamin D