Predictors of Antibody Response to Hepatitis B Vaccination in Hemodialysis Patients.

Abstract

End-stage renal disease (ESRD) patients receiving maintenance hemodialysis are at high risk of hepatitis B virus (HBV) infection and demonstrate inadequate immune response to vaccination. The objective of the study was to assess the antibody response (anti-HBs levels) of hepatitis B vaccinated maintenance hemodialysis patients. This cross-sectional observational analytical study was conducted at Marine City Medical College Hospital, Chittagong, Bangladesh for 34 months of period among 50 patients receiving maintenance hemodialysis for more than 4 months. Demographic and clinical data were collected and post-vaccination anti-HBs titers were measured. Patients were classified as high responders (anti-HBs ≥100 mIU/ml), poor responders (anti-HBs ≥10 to <100 mIU/ml) and non-responders (anti-HBs <10 mIU/ml). The mean age of participants was 52±10 years; 60.0% were male. The mean duration of dialysis was 19.7±7.7 months. The common causes of ESRD were diabetic nephropathy (58.0%), glomerulonephritis (24.0%), hypertension (12.0%) and others (6.0%). Overall, 38.0% were high responders, 26.0% poor responders and 36.0% non-responders, seroconversion rate was 64.0%. Mean anti-HBs titers were 663±463 mIU/ml in high responders, 31.55±23.24 mIU/ml in poor responders and 3.23±1.98 mIU/ml in non-responders. Age >50 years, presence of diabetes mellitus and lower serum albumin were significantly associated with poor or non response (p<0.05). Development of protective antibody levels after hepatitis B vaccination in maintenance hemodialysis patients was inadequate. Older age, diabetes and low serum albumin were important predictors of poor response. Strategies such as booster dosing and revaccination may improve seroconversion rates in this population.