Assessment of Patient and Dialysis-Related Factors Associated with Hepatitis B Vaccine Response

Abstract

The CDC recommends that all hemodialysis (HD) patients receive the hepatitis B vaccine (HBV). Response to HBV in HD patients is less than that in healthy adults and antibody to hepatitis B surface antigen (anti-HBs) levels persist for shorter periods. Reported HBV response rates among HD patients range from 34% to 88%. Objective: To identify patient-specific factors that may be associated with HBV response in HD patients. Methods: A HBV protocol was initiated at our center in 1999 and patients (n = 134) without a protective anti-HBs titer (< 10 mIU/mL) received recombinant HBV 40 mcg IM at 0, 1 and 6 months. Anti-HBs titers were monitored quarterly and booster doses were given when indicated. This retrospective cohort study included adult HD patients with sufficient seroconversion data at 12 and 24 months post-HBV vaccination. Non-paired student's t test was used to test for differences in mean age, serum albumin, and eKt/V between HBV responders (anti-HBs ≥ 10 mIU/mL) and non-responders at 12 and 24 months post-vaccination. Chi-square analysis was performed to test for differences in gender and the prevalence of diabetes mellitus (DM) at the same intervals. Results: Overall HBV response was 36.4%(n = 66) and 37.5%(n = 40) at 12 and 24 months, respectively. No statistically significant differences in age, gender, serum albumin, or eKt/V were observed between responders and non-responders at 12 and 24 months. There was no difference in the prevalence of DM at 12 months. At 24 months, 9/15 (60%) responders had DM compared to 6/25 (24%) non-responders (p ≤ 0.025). This finding was unexpected and may be a statistical aberration resulting from inadequacies in study design and sample size. Of note is the disparity between the initial number of patients and the number included in these analyses, which is due primarily to patient turnover and subsequent loss of follow-up. Conclusion: Long-term HBV response rates in our HD patients were similar to those previously reported. Larger prospective studies would be needed to confirm the finding that patients with DM had superior HBV response.