Comparison of low dose intradermal with high dose intramuscular hepatitis B vaccination in hemodialysis patients

Hemodialysis patients have a low immune response to the hepatitis B [HB] vaccine. The method of administration plays an important role in immune response establishment. This case control study compares the efficacy of intradermal [ID] and intramuscular [IM] injection methods for the HB vaccine. This study was undertaken in hemodialysis centers. We recruited 50 patients after excluding those with histories of previous HB vaccination, immunosuppressive therapy, and who were positive for HBsAb, HBsAg, and HCV antibody. Patients were randomly assigned to receive HB vaccine by either the ID or IM injection methods. The timeline for vaccine administration was 0, 1, 2 and 6 months for both groups. The ID group received 2 microg of EngerixB in both the right and left anterolateral forearms, for a total dose of 4 microg; the IM group received 20 microg in two sites in the deltoid muscle, for a total dose of 40 microg. We measured HBsAb titers at the third and seventh months following the first doses of HB vaccine. In the third month after the first HB vaccination, 40.4% of the patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 60.9% in the IM group. At the seventh month following the first HB vaccination, 68% of patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 68% in the IM group. However the mean HBsAb titer in the ID group was 459 +/- 323.8 versus 294.6 +/- 277.5 mIU/ml in the IM group. There was no significant relation between seroconversion rates for both injection methods. However the mean titers of HBsAb for both the third and seventh months after the first HB vaccination in the ID group were more than the IM group. The cost for the low dose HB vaccine in the ID group is less than the high dose vaccine for the IM group. Thus, it is beneficial to use the ID low dose HB vaccine for underdeveloped countries.

Serum triiodothyronine level as an indicator of inflammation in patients undergoing dialysis

It has been shown that inflammation affects thyroid function. In patients with end-stage renal disease, low plasma triiodothyronine [T3] may be an unsuspected expression of the inflammatory state of these patients. This study evaluated the correlation between T3 and high-sensitivity C-reactive protein [HSCRP] levels in patients on peritoneal dialysis [PD] and hemodialysis. This is a cross-sectional study aiming at the correlation between T3 and HSCRP levels among 30 patients on PD, 30 patients on hemodialysis, and 20 healthy individuals. Serum levels of HSCRP, T3, thyroxine [T4], thyroid stimulating hormone, T3 resin uptake, and free T3 index [FT3I] and free T4 index [FT4I] were compared between the three groups. There were no significant differences between hemodialysis and PD patients in respect to T3, T4, FT3I, and FT4I. In PD and hemodialysis patients, T3 and FT3I were lower than in controls [P < .001], but there was no significant difference between PD and hemodialysis patients. T3 resin uptake and thyroid stimulating hormone differed significantly between PD and hemodialysis patients. There was a significant inverse correlation between HSCRP and T3 and FT3I among hemodialysis patients [P = .04]; however, there was no such correlations in PD patients. The relationship between T3 and HSCRP suggests that inflammation might be involved in the low T3 syndrome in hemodialysis patients, but we did not find a significant correlation between T3 and HSCRP levels in patients on peritoneal dialysis

Effect of ganciclovir on pharmacokinetics of mycophenolic mofetil, in kidney transplant patients

Mycophenolate mofetil [MMF] is commonly administered concomitantly with ganciclovir for managing transplant recipients who infected with CMV, This study was conducted to evaluate the probable effects of ganciclovir on Mycophenolic acid [MPA] pharmacokinetic. Ten kidney transplant recipients who full field inclusion and exclusion criterias enrolled in this study. The first full profile blood sampling was taken during the combination therapy of gancyclovir and MMF. The second sampling was taken one week after discontinuation of gancyclovir. Serum concentrations of MPA and its glucuronide metabolite [MPAG] were determined by high-performance liquid chromatography [HPLC] method. The pharmacokinetic parameters of MPA were measured, in two conditions, for each patient. There was no significant difference between MPA clearance alone and in combination with ganciclovir [28.2 +/- 2L9 L/h vs 31.9 +/- 21.3 L/h, p=0.207] and also no significant difference was seen between the MPA Area Under the Curve [AUC] in two conditions [43.48 +/- 16.27 micro g/ml.h vs 39.80 +/- 20.18 micro g/ml.h, p=0.221]. MPAG AUC was increased significantly when the drugs were administrated in combination [957.8 +/- 675.2 micro g/ml.h vs 1348.6 +/- 1095.1 micro g/ml.h, p=0.036]. Also ganciclovir induced entrohepatic recirculation of MPA in two patients. The pharmacokinetic parameter of MPA was not affected by ganciclovir. But ganciclovir increased MPAG AUC and induced enterohepatic recirculation of MPA