Antibody level after hepatitis-B vaccination in hemodialysis patients: impact of dialysis adequacy, chronic inflammation, local endemicity and nutritional status.

We prospectively studied the evolution of HBsAg antibody (HBsAb) after primary vaccination (four doses; Engerix B, 40 pg i.m at 0, one, two and six months) in 29 patients who were seronegative (HBsAb <10 IU/L), had not been previously vaccinated and were on hemodialysis. Their mean age was 45.58 +/- 10.98 years, and the hemodialysis duration ranged from 1-21 years. In addition, we assessed dialysis adequacy for all cases on four different occasions beside the estimation of predialysis serum albumin, serum ferritin, C-reactive protein (CRP), transferrin saturation ratio (TSAT), body mass index (BMI) and subjective global assessment (SGA). We measured anti-HBs titer eight weeks after the fourth dose. Our results showed that two patients (6.90%) were nonresponders (HBsAb <10 IU/L) after the completion of vaccination. One patient (3.45%) was a weak responder (10-100 IU/L). Strikingly, 26 patients (89.65%) showed good antibody response (>100 IU/L). HBsAb titers showed no significant correlation with age, duration of HD therapy, serum albumin, CRP, TSAT level, BMI or SGA scores (p > 0.05). Responders to primary vaccination had significantly higher levels of urea reduction ratio (%) and Kt/V compared to nonresponders (63.61 +/- 6.97% and 1.25 +/- 0.15 vs. 52.0 +/- 2.10% and 0.92 +/- 0.13, respectively, P < 0.05). In conclusion, this was a preliminary study showing a very high response to hepatitis-B vaccination among hemodialysis patients that neither correlated with age, systemic inflammation nor nutritional status. Efficient hemodialysis was associated with good response to hepatitis-B vaccine.

Management of Pre-end Stage Renal Failure in Egypt.

A specially designed questionnaire was used to explore the predominant trends of pre-end stage renal failure in Egypt. A random sample of 47 physicians dealing with such patients was chosen to fill the questionnaire during a recent scientific gathering. They were of different ages, qualifications, years of experience and health-care disciplines. Collected data were entered into a computer database and subjected to statistical analysis and correlation with relevant physicians backgrounds. The study shows that the Egyptian trends are generally conforming to respective international recommendations; major deviations being largely the result of economical shortcomings. There was no significant impact of physician-related factors on patient management trends.