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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 672-674
Factors affecting on hepatitis B seroprotection in hemodialysis patients


Pediatric Nephrology Ward, Sevom-e-Shaban Hospital, Tehran, Iran

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Date of Web Publication18-May-2017
 

How to cite this article:
Malaki M. Factors affecting on hepatitis B seroprotection in hemodialysis patients. Saudi J Kidney Dis Transpl 2017;28:672-4

How to cite this URL:
Malaki M. Factors affecting on hepatitis B seroprotection in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Nov 16];28:672-4. Available from: http://www.sjkdt.org/text.asp?2017/28/3/672/206472
To the Editor,

Hemodialysis (HD) patients are more prone to hepatitis B virus (HBV) infection. Immunity acquired by hepatitis B (HB) vaccine in these patients is often inadequate. The presence of HBV infection is important due to the fact that affected patients may have significant clinical deterioration after transplantation.[1] End-stage renal disease (ESRD) patients, either on dialysis or not, show lower immune response rates (50%-80%) to the vaccine when compared with immunocompetent individuals (95%).[2] Antibody response against HBV has improved up to 80% in HD patients by doubling the dose (40 pg/dose) and also by administering an additional dose.[2],[3] Blood antibody levels of HB antigen (anti-HBs) >10 IU/L are considered protective in healthy individuals; however, there is a belief that higher levels (>100 IU/L) are desirable in patients on chronic HD.[3] This study tries to find HBV immune response among our HD patients. In a cross-sectional study, 77 patients undergoing HD for over six months, three times weekly, each of whom received four doses of 40 pg of HB vaccine which were given into deltoid muscle at 0, 1, 2, and 6 months after dialysis initiation and after considering the exclusion criteria (carrier state or persistent HB). Their serum antibody levels against HB were checked one to two months after the last dose using enzyme-linked immunosorbent assay test. The titers were divided into three categories: nonresponder <10 IU/L, weak responder with 10–100 IU/L, and good responder >100 IU/L. Comparison of variables was done between groups by ANOVA test and Chi-square test, P <0.05 was considered statistically significant. There were 32 females and 45 males. The age of cases was 61 ± 15 (mean ± standard deviation) years, 22% of cases were nonresponders, and 78% of cases responders (HBS antibody >10). Hemoglobin level was lower (9.8 ± 1.3 g/dL) in non responders compared to respon- ders (10.8 ± 1.6). This difference was significant (P = 0.02), but the difference was not significant between weak and high responders. Age was not different between groups of non- responders and responders (P = 0.23). Urea level was lower significantly in nonrespon- ders, i.e., 102 ± 29 mmol/L compared to responders, i.e., 120 ± 35 (P = 0.02), but this difference was not significant between weak and high responders [Table 1]. Inflammatory indices such as erythrocyte sedimentation rate were higher in responders (63 ± 49) compared to responders (42 ± 38), but this difference was not significant [Table 1]. The persistence of immunity in HD patient is not long lasting, and after three years, 41% of responders lost their immunity. In addition, age also has an effect on persistence of immunity.[4] The antibody titer drops up to 50% in chronic renal failure and 15% of general population after one year.[5] It has been shown that age, duration of HD, nutritional factors, and phase reactive proteins such as C-reactive protein are ineffective in prediction of immune response rate but urea clearance ratio have positive effect on this response (HB antibody >100) that may reach up to 89% among those with a mean age of 45 years.[6] This study showed a response in 78% of patients undergoing HD. However, immune response rate had no relation between age, diabetes, fasting blood sugar, high HbA1c measures, and erythrocyte sediment rate as inflammatory index. Hemoglobin level can have an effect on antibody response, but this effect is partial and significant only between responders and nonresponders. Serum urea is another factor that influences the response rate for levels between 10 and 100 but not for over 100 IU/L measures. It may be related to the fact that predialysis urea level has a J shape effect on patient’s prognosis and clinical characters.[7]
Table 1: The effects of factors that may effect on seroprotection against hepatitis B in hemodialysis patients.

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Gender, age, ESRD duration, inflammatory condition, and albumin level have no effect on HB immune response, whereas predialysis session urea and hemoglobin level can effect partially on vaccination response rate, but they cannot guarantee HB antibody rising over 100 IU/L or to have a long-lasting response. It seems that chronic renal failure patients have an incomplete response to HB vaccination, and the best time for vaccination in these patients is before urea levels rise and hemoglobin levels drop.


   Acknowledgment Top


I give my thanks to Dr. Farnaz Barzi for her valuable information that helps me to write this paper.

Conflict of interest: None declared.

 
   References Top

1.
Tsai MC, Chen YT, Chien YS, Chen TC, Hu TH. Hepatitis B virus infection and renal transplantation. World J Gastroenterol 2010; 16:3878-87.  Back to cited text no. 1
[PUBMED]    
2.
Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic haemodialysis patients. MMWR Morb Mortal Wkly Rep 2001;50:1-43b.  Back to cited text no. 2
    
3.
Ayub MA, Bacci MR, Fonseca FL, Chehter EZ. Hemodialysis and hepatitis B vaccination: A challenge to physicians. Int J Gen Med 2014; 7:109-14.  Back to cited text no. 3
[PUBMED]    
4.
Fabrizi F, Di Filippo S, Marcelli D, et al. Recombinant hepatitis B vaccine use in chronic hemodialysis patients. Long-term evaluation and cost-effectiveness analysis. Nephron 1996;72:536-43.  Back to cited text no. 4
[PUBMED]    
5.
Kausz A, Pahari D. The value of vaccination in chronic kidney disease. Semin Dial 2004;17:9- 11.  Back to cited text no. 5
[PUBMED]    
6.
Ibrahim S, El-Din S, Bazzal I. Antibody level after hepatitis-B vaccination in hemodialysis patients: Impact of dialysis adequacy, chronic inflammation, local endemicity and nutritional status. J Natl Med Assoc 2006;98:1953-7.  Back to cited text no. 6
[PUBMED]    
7.
Stosovic M, Stanojevic M, Simic-Ogrizovic S, Jovanovic D, Djukanovic LJ. Relation between serum urea and mortality of hemodialysis patients. Ren Fail 2009;31:335-40.  Back to cited text no. 7
[PUBMED]    

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Correspondence Address:
Dr. Majid Malaki
Pediatric Nephrology Ward, Sevom-e-Shaban Hospital, Tehran
Iran
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DOI: 10.4103/1319-2442.206472

PMID: 28540917

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