Response rate to hepatitis B vaccination in patients with chronic renal failure and End-stage-renal-disease: Influence of diabetes mellitus

ABSTRACT

Hepatitis B vaccination is recommended for all individuals with renal failure. Nevertheless, the response rate for this vaccine in hemodialysis patients is low. This study was designed to determine the response rate to hepatitis B vaccination in chronic renal failure [CRF] and end stage renal disease [ESRD] patients and those factors that influence it. We evaluated antiHBs level after primary vaccination in 32 predialysis and 93 dialysis patients. HBsAg positive patients were excluded. AntiHBs titers were determined in the period of 1 to 6 months after completion of vaccination. Seroconversion [antiHBs >/= 10mIU/ml] was found in 100 patients [80%], but an excellent response [titer>100 mIU/ml] was observed only in 74 [59.2%]. Response rate were 71.9 and 82.8 in predialysis CRF and ESRD patients, respectively, but this difference was not significant [patients showed an excellent response more than dialysis patients [sex, and initial serum creatinine didn't influence response rate. Response rate in patients with diabetic mellitus was lower than others [62.2% vs. 87.5%] [logistic regression analysis showed a significant risk for vaccination nonresponse when patients were diabetics [odds ratio 4.38; 95% confidence interval 1.70-11.24, p=0.002]. Our result showed that 1] hepatitis B vaccine nonresponders are more likely to have diabetes mellitus and 2] response rate in predialysis patients is the same as in dialysis patients but predialysis patients, as compared with dialysis patients, were more inclined to show an excellent response