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.