[Does efficient haemodialysis improve the response to hepatitis B virus vaccination?]. / Poboljsava li ucinkovitija hemodijaliza odgovor na cijepljenje protiv virusa hepatitisa B?

Patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus vaccine. We conducted this study to demonstrate factors which could affect response to HBV vaccination. Subjects were 30 PCHD. All subjects were vaccinated with 4x40 microg recombinant HBV vaccine given i.m. at intervals 0, 1, 2, and 6 months. Subjects were divided into groups according to the level of antibody (HbsAb): nonresponders (<10 i.u./L), weak responders (10-100 i.u./L), and good responders (>100 i.u./L). A statistically significant difference was found between responders and nonresponders in the dialysis efficiency (Kt/V) (p=0.027). A multivariate analysis of variance unveiled a significant difference between the groups of nonresponders, weak and good responders in the Kt/V value (p=0.028), and the subject age (p=0.080). Positive correlation between HBsAb level and Kt/V (r=0.46; p=0.006), and negative correlations between HBsAb and: subject age (r=-0.40; p=0.026), existence of diabetes (r=-0.32; p=0.041), blood leukocyte number (r=-0.31; p=0.050), and body mass index (r=-0.42; p=0.011) were demonstrated. A multiple linear regression analysis demonstrated the most significant positive correlation between HBsAb level and the Kt/V values (p=0.002), and negative correlation between HBsAb level and the subject age (p=0.047). The HBV vaccination response was weaker in PCHD with inefficient dialysis and older age. Efficient haemodialysis most significantly improves the response to vaccination.

[Hepatitis B vaccination in patients on chronic hemodialysis]. / Cijepljenje protiv hepatitisa B na kronicnoj hemodijalizi.

Patients on chronic haemodialysis (PCHD) respond less well to vaccination with recombinant hepatitis B virus superficial antigen (HbsAg) because of immunity disorders in uraemic patients. Today many schemes and vaccination modification for nonresponding PCHD are proposed. The reaction on vaccination with HbsAg is weaker in those PCHD who had diabetes, older age and insufficient nutritive parameters. In those patients some alternative schemes of vaccinating for nonrespondering PCHD must be considered, especially one of the proposed intradermal ways of vaccine inoculation.

[Renal dyslipidemia in patients on chronic hemodialysis]. / Renalna dislipidemija u bolesnika na kronicnoj hemodijalizi.

Disorder of blood lipids plays an important role in atherosclerosis progress in patients ongoing chronic haemodialysis (PCHD). These patients have specific features of blood lipids with increment of triglycerides and decrement of HDL-cholesterol. Phenotype of lipid disorder in PCHD is mostly type IV according to Fredrickson (30%), and IIA and IIB fenotypes are less frequent. About 9% of lipid disorders in PCHD are isolated increase of Lp(a). Main reason of hypertriglyceridemia in PCHD is attenuated metabolism of VLDL-cholesterol because of lipoprotein lipasis inhibition. There are changes in lipoproteins quality, specially changes in LDL particle have atherogenic potential. Renal dyslipidemia treatment must be vigorous in the early stages of renal insufficiency. Treatment can be dietary measures (specially omega-3-fatty acids), statins, gemfibrozil, intravenous L-carnitin and bicarbonate given per os. Haemodialysis modifications such as highflux haemodialysis, low molecular weight heparin, vitamin E coated dialyzers and LDL-apheresis in extreme cases have important role in renal dyslipidemia treatment.

Efficient haemodialysis improves the response to hepatitis B virus vaccination.

BACKGROUND: As patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus surface antigen (HBsAg), we conducted this study to see how dialysis efficacy affects response to hepatitis B virus (HBV) vaccination. METHODS: Study subjects consisted of 30 PCHD. All subjects were vaccinated with 4 x 40 microg HBsAg i.m. at 0, 1, 2, and 6 months. If a subject had an HBsAg antibody (HBsAb) level <10 IU/l after vaccination, he or she received a booster dose. Subjects were divided into groups according to the level of HBsAb: non-responders (<10 IU/l), weak responders (10-100 IU/l), and good responders (>100 IU/l). RESULTS: The group of responders had a significantly more efficient dialysis (Kt/V) than the group of non-responders (p = 0.027). This difference was not observed between groups of non-responders and weak responders. The group of good responders had a significantly better Kt/V than the group of non-responders (p = 0.012). Good responders had a significantly better Kt/V than weak responders (p = 0.019). Kt/V values showed a significantly positive correlation with the HBsAb level (r = 0.47; p = 0.006). CONCLUSIONS: The HBV vaccination reaction was weaker in PCHD with inefficient dialysis. Efficient haemodialysis significantly improves the response to vaccination with recombinant HBsAg.