Majid Malaki
Majid Malaki . Pediatric nephrologist . Tehran . Iran
Title: Factors Affecting on Hepatitis B Seroprotection in Hemodialysis Patients
Biography
Biography: Majid Malaki
Abstract
Hemodialysis (HD) patients are more prone to hepatitis B virus (HBV) infection. Immunity acquired by hepatitis B (HB) vaccine in these patients is often inadequate. The presence of HBV infection is important due to the fact that affected patients may have significant clinical deterioration after transplantation.1 End-stage renal disease (ESRD) patients, either on dialysis or not, show lower immune response rates (50%–80%) to the vaccine when compared with immunocompetent individuals (95%).2 Antibody response against HBV has improved up to 80% in HD patients by doubling the dose (40 μg/dose) and also by administering an additional dose.2,3 Blood antibody levels of HB antigen (anti-HBs) ≥10 IU/L are considered protective in healthy individuals; however, there is a belief that higher levels (>100 IU/L) are desirable in patients on chronic HD.3 The persistence of immunity in HD patient is not long lasting, and after three years, 41% of responders lost their immunity. In addition, age also has an effect on persistence of immunity.4 The antibody titer drops up to 50% in chronic renal failure and 15% of general population after one year.5 It has been shown that age, durationof HD, nutritional factors, and phase reactive proteins such as C-reactive protein are ineffective in prediction of immune response rate but urea clearance ratio have positive effect on this response (HB antibody ≥100) that may reach up to 89% among those with a mean age of 45 years.6 our study show Gender, age, ESRD duration, inflammatory condition, and albumin level have no effect onHB immune response, whereas predialysis session urea and hemoglobin level can effect partially on vaccination response rate, but they cannot guarantee HB antibody rising over 100 IU/L or to have a long-lasting response. It seems that chronic renal failure patients have an incomplete response to HB vaccination, and the best time for vaccination in these patients is before urea levels rise and hemoglobin levels drop.