EFFECT OF RENAL HEMODIALYSIS IN END STAGE RENAL DISEASES ON THE LEVEL OF HEPATITIS SURFACE ANTIBODIES AFTER VACCINATION

Abstract

Background: The prevalence of viral hepatitis is higher in end stage renal diseases(ESRD) patients with dialysis than in general population, because of the opportunity for exposure during dialysis to blood products, and shared hemodialysis equipments. The impaired efficacy of HBV vaccine has been attributed to numerous factors such as immune compromised state because of uraemia, age. Immunization is the most effective way to prevent transmission of HBV. Objective: To evaluate the effect of chronic renal hemodialysis on the level of hepatitis B surface antibodies after vaccination and to compare between immunogenic seroconversion response to HBV vaccine in hemodialysed patients and healthy individuals. Patients and Methods: One hundred eighty cases were included in the study (60 controls and 120 hemodialysed patients) at national institute of urology and nephrology (NIUN). The patients were subdivided into 2 subgroups: 1) Sixty hemodialysed diseased patients due to immunological disease. 2) Sixty hemodialysed diseased patients due to other causes of renal diseases including diabetes mellitus (D.M.) and hypertension (HT). All subjects received 3 doses of HBV vaccine starting from 11/2013 till 5/2014 (0,1, 6 months). Patients have double the dose (2 ml) of the controls. After one year of complete vaccination, all subjects were investigated for Hepatitis B surface antibodies titer (HBs Abs titer) in their sera. RESULTS: There was a statistically significant difference between patient and control groups as regards urea, creatinine, uric acid, sodium, and potassium. No statistically difference between male and female patients as regards HBs Abtiter, and statistically significant difference of HBs Ab seroconversion when comparing between patients and controls. There was a statistically significant difference between subgroup 1and subgroup 2. No significant correlation between age, adequacy of dialysis, and HBsAb titer in groups of patients. Conclusion: The study reported a high response rate to hepatitis-B vaccination among hemodialysed patients. Gender and efficiency of dialysis have no association with response to HBV vaccine. Young age was associated with good response to hepatitis B vaccine, while diabetes mellitus has a poor response to hepatitis B vaccine.