ABSTRACT
Background: Hemodialysis patients are vulnerable to infections with Hepatitis B Virus and hepatitis C virus [HCV]. Patients who are on maintenance hemodialysis are considered as high-risk group for acquiring hepatitis B virus, resulting in high morbidity and mortality. Therefore, to vaccinate them against the virus is mandatory. Compared to a response rate of over 90% in the normal population, only 50 to 60% of those with end-stage renal disease achieve adequate antibody levels following immunization and the objective of this study was to determine the antibody level after Hepatitis B vaccination in chronic hemodialysis patients
Methods: 118 patients, undergoing chronic hemodialysis [HD] at the dialysis unit of Liaquat National Hospital, fulfilling the inclusion and exclusion criteria were enrolled between April 2013 and September 2013, after taking informed consent and approval from ethical review committee. AntiHbs [Hepatitis B surface antibody] titers were measured. Patients were differentiated as Immune and non immune based on antibody titers, with levels of >10IU/l being considered as immune and levels of <10IU/las non immune. AntiHbs titer was measured by ELISA [Enzyme Linked Immunosorbant Assay]. Data was analyzed using SPSS version 14.0 for windows. Chi square test were used to ascertain the statistical significance. P value <0.05 was taken as statistically significant. In addition, the effect of age, gender and duration of Hemodialysis on antibody titer was also observed
Results: Out of 118 patients enrolled, 103 [87.3%] had an adequate antibody response and were considered immune while only 15 patients [12.7%] had an inadequate antibody response rendering them non immune. AntiHbs titers showed no significant co-relation with gender and duration of Hemodialysis therapy[p>0.05], while age was found to have significant correlation as younger age group [<60years] had more immune response [p<0.001]
Conclusion: Our study showed a very good antibody response to Hepatitis B vaccination among hemodialysis patients that correlated with age with younger age group having a better response but no correlation to gender and duration of dialysis
ABSTRACT
To determine frequency of different vascular access use in Incident hemodialysis [HD] patients and determine whether predialysis care in terms of timely advice for vascular access placement was better in the hands of nephrologist. A cross sectional study was conducted. Data was collected on the type of access used for first HD, including temporary Central venous catheters [CVC], permanent CVC [Permacath], arteriovenous fistula [AVF], or arteriovenous graft [AVG]. In addition, information was also gathered if patients were aware of their renal disease and was followed by other physicians or nephrologist. A total of 120 patients were enrolled in the study, 80% required CVC as their first access for HD [96/120 patients] out of which 74.2% were dialyzed through temporary catheter and 5.8% through Permacath. About 20% of patients were dialyzed through mature Arteriovenous [AV] access. Majority [95.8%] of patients were being followed by any health care provider. 68% of them were aware of their renal disease. About 55.8% were referred to nephrologist and 40% were followed by other physicians. About 83.5% of patients followed by nephrologist were advised AV access prior to commencing HD, compared to only 10.4% followed by other physicians [p < 0.05]. 24/61 [39.3%] patients that were advised AV access by both groups had timely made AV access and underwent HD by it. Very high incidence of temporary HD catheter was used in Incident HD patients. Moreover, pre dialysis care in terms of placement of AV access prior to initiating HD is better in the hands of nephrologist and patients should be timely referred to nephrologist especially when they have Stage 4 chronic kidney disease [CKD]