Introduction:
Chronic kidney disease (CKD) patients gradually become immunocompromised with declining renal function. They become highly susceptible to various infections specially blood-borne infections like Hepatitis B Virus (HBV). Active immunization against HBV is recommended routinely for them. But immune response following vaccination is usually suboptimal in these patients, specially those who are on hemodialysis than healthy individuals. Immune response to Hepatitis B vaccination may vary due to different reasons. This study was aimed to determine the immune response to hepatitis B vaccination in CKD patients and possible factors associated with non-response.
Methods:
This prospective study was carried out in the department of Nephrology, in a tertiary medical college hospital. A total of 100 patients were distributed in two groups- 50 patients of CKD stage 3-5 on conservative management and 50 patients on maintenance hemodialysis (MHD) who were receiving routine Hepatitis B vaccination- were enrolled in the study. Demographic, clinical, and laboratory data were collected initially. Patients from both groups received 40 µg recombinant DNA Hepatitis B vaccine intramuscularly in the deltoid region at 0, 1, 2, and 6th month schedule. Then after 8 weeks of the last dose of vaccine anti- Hepatitis B surface antibody (Anti- HBs Antibody) titer was measured. Seroconversion was defined as an antibody titer 10mIU/ ml and according to the titer study population was divided into 3 sub-groups: adequate (>100mIU/ml), inadequate (10 - 100mIU/ ml) and non-responders (<10mIU/ml) and then different variables were compared among them to find out the possible factors that may be associated with non-response following Hepatitis B vaccination in CKD patients.
Results:
The seroconversion rate was 79.5% in patients with CKD stage 3-5 (ND) whereas among MHD patients it was 55.1% following Hepatitis B vaccination. 52.2% of CKD (ND) and 20.4% of MHD patients achieved adequate immune response. Despite complete vaccination, 20.4% patients of CKD stage 3-5 and 44.9 % patients of MHD were non-responders. Non- responders were comparatively older in age with higher BMI, lower serum albumin and eGFR levels than the responders.
Conclusions:
An adequate immune response following Hepatitis B vaccination may be achieved if it is administered during early stages of CKD, preferably before initiating dialysis. Modification of certain factors before immunization may bring better results.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.