217 Immune Response to Hepatitis B Vaccine in End Stage Renal Disease Population

Abstract

IMMUNE RESPONSE TO HEPATITIS B VACCINE IN END STAGE RENAL DISEASE POPULATION Lakshmi P. Nadimpalli, Prajwol R Pant, Earl C. Smith, Janos Molnar, Ashok K. Singh, Krishnamurthy P Gudehithlu and Andres Serrano. Department of Nephrology, Mt. Sinai Hospital / Chicago Medical School, Chicago, IL,USA and Department of Nephrology, John H. Stroger Hospital of Cook County, Chicago, IL,USA. End-Stage Renal Disease patients have a low seroconversion rate compared to the general population, following Hepatitis B vaccination. We conducted a prospective study to evaluate the possible association between inflammation (measured by TNF , CRP & ferritin) and the immune response following Hepatitis B Vaccination and to identify clinical parameters that can predict seroconversion. Thirty five ESRD patients who were negative for hepatitis B surface antigen and antibody, received 40 g of Hepatitis B Vaccine in the deltoid muscle at 0, 1 & 6 months. Immune response to vaccine was evaluated 1 month after completion of the vaccination series by quantitative antibody titers. Clinical parameters and inflammatory markers were compared between patients who responded and those who did not. Patients who responded to Hepatitis B Vaccine (22 or 63%) were younger than those who did not (53.95 +/15.47 vs. 68.85 +/9.67, p=0.018). There were no differences in other parameters (sex, ethnicity, type of access, number of years on hemodialysis, urea reduction ratio, serum iron, hemoglobin, albumin, PTH, calcium, phosphorus and bicarbonate), and in the use of erythropoietin stimulating agents or vitamin D analogues between the two groups. We specifically evaluated the association of inflammatory markers (TNF , CRP, ferritin) with seroconversion after Hepatitis B Vaccination, but there were no differences between the two groups. Patients were also stratified according to their Hepatitis B antibody titers, but there were no differences in any of the parameters described. In conclusion, the immune response to Hepatitis B Vaccination in chronic HD is low as compared to the general population. Younger age seems to be associated with an adequate response to vaccine. We did not identify any association between inflammation, measured by inflammatory markers and the lack of seroconversion after vaccination.