Comparison of Factors Affecting the Immune Response to Hepatitis B Vaccination in Patients with Stage 5 Chronic Kidney Disease-haemodialysis and Predialysis

Abstract

To evaluate the factors that affect the immune response to Hepatitis B vaccination in the Stage 5 chronic kidney disease population (Haemodialysis and Predialysis). Eligible Stage 5 chronic kidney disease patients on haemodialysis (Cohort A: N= 39) and Predialysis (Cohort B: N=56) in an outer metropolitan renal service in Western Australia with no prior Hepatitis B infection or vaccination between Jan 2015 to Dec 2021 were involved in this retrospective cohort study. Serological response to Hepatitis B vaccination (H-B-VAX II 40 mcg intramuscularly at 0, 1 and 6 months) was evaluated six-eight weeks post-vaccination. Factors such as age, gender, diabetes mellites, cardiovascular disease, hypertension, chronic obstructive airway disease, serum albumin, and erythropoietin stimulating agent dependence were studied for their influence on immune responses in these cohorts. There were 95 eligible respondents in the study. Cohort B (Predialysis) showed a significantly higher response than Cohort A (Haemodialysis) (66.1% vs 53.8%) (p=0.003). Different factors affecting the vaccine response were identified in the two cohorts. Serum albumin <35g/L was associated with negative response in 61.1% (p =0.0023)Cohort A HD patients. In the Predialysis Cohort B, 84.2%(p=0.026) were male gender, 63.2%(p=0.028) with the presence of cardiovascular disease, and 57.9%(p=0.001) who were Erythropoietin dependent showed a negative response to the vaccine. This study showed that the Hepatitis B vaccine response was lower in HD patients than in Predialysis patients with stage 5 chronic kidney disease. Clinical factors of serum albumin, cardiovascular disease, and patient factors of gender and erythropoietin dependence were identified as factors that affected vaccine response in these two cohorts. We postulate these factors to be considered in the hepatitis B vaccination management to enhance immunological response strategies and extend to earlier stages of chronic kidney failure.