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Hemodial Int. 2003 Oct 1;7(4):296-303. doi: 10.1046/j.1492-7535.2003.00053.x.

Hepatitis B virus vaccine response in hemodialysis: baseline patient characteristics.

Author information

1
Division of Nephrology, University of California at Davis, Sacramento, California, U.S.A. tam041198@aol.com

Abstract

BACKGROUND:

Hepatitis B virus (HBV) vaccination is recommended for all individuals with renal failure. Nevertheless, the response rate for this vaccine in hemodialysis (HD) patients is low, ranging from 50% to 80%. The goal of this study was to determine patient characteristics at the initiation of HD that influence HBV vaccine response.

METHODS:

Patients new to HD in an urban population in the United States were retrospectively examined. Analyzed patients were HBV antibody and antigen negative and hepatitis C virus antibody negative at the start of HD, who received HBV recombinant vaccine. Nonresponse was defined as failure to seroconvert (>10 UI/L) after six deltoid intramuscular injections of vaccine. Response was defined as a lasting seroconversion (at least two consecutive positive titers) with </=6 injections. Demographic, laboratory, and kinetic modeling data were examined.

RESULTS:

A total of 33 nonresponders and 64 responders were identified. Univariate analysis demonstrated that nonresponders were older (59 vs. 51 years), had a higher prevalence of diabetes mellitus (DM) (70 vs. 39%), had lower serum albumin levels (3.2 vs. 3.3 g/dL), and had higher dry weights (84 vs. 71 kg) than responders at HD start. In addition, nonresponders had lower normalized protein catabolic rates (0.74 vs. 0.85 g/kg/day) and lower (single-pool) spKt/V(urea)values (0.95 vs. 1.19). Nonresponders had lower serum creatinine levels than responders, despite the greater dry weights. In a multiple logistic analysis model, the presence of DM, age >/= 55 years, body weight >/=80 kg, and normalized protein catabolic rate </=0.75 g/kg/day were associated with HBV vaccination nonresponse. At the end of the vaccination period, nonresponders versus responders continued to have lower serum albumin (3.5 vs. 3.8 g/dL) and creatinine levels (7.8 vs. 10.0 mg/dL) and spKt/V(urea)(1.27 vs. 1.39).

CONCLUSION:

Hepatitis B vaccine nonresponders on HD are older, are more likely to have DM, are more malnourished, and have lower spKt/V(urea) than responders. Nonresponders may also have a different body composition with a lower ratio of lean to total body mass.

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