Comparison of seroconversion rates after hepatitis B vaccination in patients with advanced chronic kidney disease and those receiving maintenance hemodialysis.
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Abstract
Background: Patients receiving dialysis are at an increased risk of hepatitis B virus (HBV) infection due to a compromised immune system. While HBV vaccination is recommended, the response rate to the standard vaccination regimen (3 doses of 10 µg HBV vaccine) among patients with chronic kidney disease (CKD) or receiving hemodialysis in Japan is unclear. This study evaluated the seroconversion rate, optimal timing, and CKD stage in patients receiving HBV vaccination.
Methods: In this prospective, observational study conducted from May 2021 to July 2024, patients with advanced CKD not on dialysis and those receiving maintenance hemodialysis at two centers in Japan received 3 doses of 10 µg HBV vaccine at 0, 1, and 6 months. The primary outcome was the seroconversion rate, defined as anti-HBs antibody levels of ≥10 IU/mL, measured 1-3 months after the third dose.
Results: Overall, 113 participants (63 with non-dialysis CKD and 50 with hemodialysis CKD) were included. The seroconversion rates were 64.3% in non-dialysis patients and 54.2% in patients on hemodialysis, with no significant difference (OR = 0.62, 95% CI 0.28-1.38). Multivariate analysis adjusting for covariates showed no significant difference (OR = 0.74, 95% CI 0.29-1.91), and sensitivity analysis confirmed this finding.
Conclusions: The seroconversion rate of the standard HBV vaccination (3×10 µg) was not significantly different from those in non-dialysis patients with CKD. More effective vaccination strategies such as higher doses, third-generation vaccines, or vaccination at an earlier CKD stage are required to improve HBV protection in this population.
期刊介绍：
Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.
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